While the effects of high altitude on the endocrine systems, energy intake, resting metabolic rate and body mass are severe, it appears that resting metabolic rate is also increased, albeit to a smaller extent, at low to moderate altitudes, and targeting adequate energy intake is important for optimizing health and appears to be an emerging factor associated with optimizing altitude adaptations.

Despite being iron-replete, a blunted erythropoietic response is observed in non-iron supplemented athletes during simulated altitude, with data demonstrating that most athletes will maximize the hypoxia-induced increases in hemoglobin mass while consuming ~ 100–200 mg of elemental iron daily in oral form, with most evidence coming from iron salts.

There is insufficient evidence to recommend high-dose single antioxidant supplementation to attenuate altitude-induced oxidative stress, as this may actually impair endurance and altitude-based training adaptations; although this does not seem to occur with the integration of ample amounts of antioxidant-rich foods into athletes’ daily diets.