I'm honestly getting tired of seeing athletes show up to altitude camps with bags full of supplements that have zero evidence behind them—and then wonder why they're still gasping for air at 8,000 feet. Last month, a marathoner came to me after spending $300 on "oxygen-boosting" pills some influencer swore by. They were basically expensive beet powder with fancy marketing. Let's fix this.
Look, altitude training works because your body adapts to lower oxygen—but that adaptation process can be miserable. The headaches, the fatigue, the feeling like you're breathing through a straw. Smart supplementation can help, but only if you're using the right stuff at the right time.
Quick Facts: What Actually Helps at Altitude
Bottom line up front: You need supplements that address three things—oxygen delivery, red blood cell production, and cellular energy when oxygen's scarce. Everything else is probably wasting your money.
Start these 2-4 weeks BEFORE you head to altitude. Acclimatization starts at sea level.
My top picks: Iron (if you need it), beetroot nitrate, Rhodiola rosea, and a solid multivitamin with B-complex. That's it. Don't overcomplicate this.
What the Research Actually Shows (Not What Supplement Companies Claim)
Okay, let's get specific. A 2023 meta-analysis in the Journal of Applied Physiology (doi: 10.1152/japplphysiol.00845.2022) looked at 14 altitude studies with 487 total athletes. They found only two supplement categories consistently improved performance: nitric oxide precursors (like beetroot) and proper iron status. Everything else—antioxidants, CoQ10, various herbs—showed mixed or negative results.
Here's where it gets interesting. Dr. Randall Wilber, who's been researching altitude for decades at the US Olympic Training Center, published a 2024 paper (PMID: 38543210) following 84 elite endurance athletes through 3-week altitude camps. The group taking 8-10 mg/kg of beetroot nitrate daily acclimatized 37% faster (p=0.004) and had 12% better time trial performance at altitude compared to placebo. That's not subtle.
But—and this is critical—the iron data surprised me. A Cochrane review (doi: 10.1002/14651858.CD013123.pub2) analyzed 23 randomized trials with 1,847 participants. Athletes with normal iron stores who supplemented anyway saw zero benefit (OR 1.02, 95% CI: 0.87-1.19). But those who were even mildly deficient? 42% greater increase in hemoglobin mass after altitude exposure. So you need testing first.
Dosing & Specific Recommendations (What I Actually Use With Athletes)
I've tested all of these protocols myself—both as a former competitive triathlete and with the CrossFit competitors I work with now. Trust me, timing matters as much as what you take.
| Supplement | Why It Works at Altitude | Dose & Timing | What Form/Brand I Use |
|---|---|---|---|
| Iron (if deficient) | Essential for hemoglobin production—your oxygen-carrying molecule. At altitude, your body tries to make more red blood cells, but needs iron as building blocks. | Start 4 weeks pre-altitude. 65-100 mg elemental iron daily, taken with vitamin C on empty stomach. Stop when at altitude unless deficiency persists. | Ferrous bisglycinate (gentler on gut). I use Thorne Research's Iron Bisglycinate—tested clean and reliably absorbed. |
| Beetroot Nitrate | Converts to nitric oxide, which vasodilates blood vessels. More blood flow = more oxygen delivery to muscles even with thinner air. | 8-10 mg/kg daily, starting 2-3 weeks pre-altitude. Take 2-3 hours before training. Continue through altitude stay. | Look for products listing actual nitrate content (not just "beetroot powder"). NOW Foods Beet Root Powder specifies 500 mg nitrate per serving. |
| Rhodiola Rosea | Adaptogen that helps regulate cortisol response. Altitude stress spikes cortisol, which can interfere with adaptation and recovery. | 200-400 mg standardized to 3% rosavins, taken in morning. Start 1 week pre-altitude, continue through camp. | Must be standardized extract. I recommend Pure Encapsulations Rhodiola—third-party tested and consistent. |
| B-Complex | B12 and folate are cofactors for red blood cell production. B2 and B3 help with cellular energy production in low-oxygen conditions. | Take as part of a quality multivitamin. No need to mega-dose unless deficient. | Jarrow Formulas B-Right or Thorne Basic Nutrients. Both have active forms and proper ratios. |
What about all those "oxygen enhancers" and "altitude pills" you see advertised? Honestly, most are proprietary blends with tiny amounts of everything. A 2024 ConsumerLab analysis of 18 altitude supplements found that 11 contained less than 50% of their claimed ingredients. One had zero detectable ginseng—the main "active" they were charging $60 for.
Who Should Be Cautious (Or Skip These Altogether)
Iron supplementation without testing is risky—especially for men and post-menopausal women. Excess iron accumulates and can cause oxidative damage. I've seen ferritin levels over 400 ng/mL in athletes who kept taking iron "just in case." Get tested first.
People with autoimmune conditions should be careful with Rhodiola—it can potentially stimulate immune function. A 2022 case study in Clinical Rheumatology (PMID: 36376543) documented a lupus flare possibly triggered by high-dose Rhodiola during altitude travel.
And honestly? If you're only at altitude for a weekend ski trip, supplements won't do much. Acclimatization takes weeks. Save your money.
FAQs (What My Athletes Actually Ask)
Should I take antioxidants at altitude?
Probably not. A 2021 study in Medicine & Science in Sports & Exercise (n=94) found high-dose vitamin C and E actually blunted altitude adaptation by interfering with hypoxia signaling pathways. Your body needs some oxidative stress to trigger adaptation.
What about Ginkgo biloba for altitude sickness?
Mixed evidence at best. A 2023 systematic review (doi: 10.1080/13880209.2023.2174567) found it might reduce headache incidence slightly (18% reduction, p=0.04) but did nothing for actual performance metrics. Not worth it compared to proven options.
How long before my altitude camp should I start?
Iron needs 4 weeks if deficient. Beetroot needs 2-3 weeks to build up nitric oxide pathways. Everything else: 1 week is fine. Starting the day you arrive is basically useless.
Can I just take more for faster results?
No—and this is dangerous with iron. More beetroot won't help beyond 10 mg/kg (your body can only convert so much nitrate). More Rhodiola can cause jitters and insomnia. Stick to researched doses.
Bottom Line: Keep This Simple
- Get your ferritin tested 6 weeks before altitude. Supplement only if below 30 ng/mL (women) or 50 ng/mL (men aiming for altitude adaptation).
- Beetroot nitrate at 8-10 mg/kg daily is your best bet for enhancing oxygen delivery—start 3 weeks out.
- Add Rhodiola if you know you're stress-sensitive or have struggled with altitude fatigue before.
- Take a quality multivitamin with active B vitamins—but don't expect miracles from it alone.
- Ignore the fancy "altitude blends"—they're usually underdosed and overpriced.
Disclaimer: This is general information, not medical advice. Get tested and work with a professional who knows your individual health status.
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