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Hi, everyone. My name is R. Uh Thanks for sharing your interest in signing up for the Endeavor, medical course and the attitude and practice. Uh I'm going to be delivering this presentation on expedition nutrition. Um And so I thought I'd start with a little bit about me introducing myself um and giving a bit of background as to why it is that I'm, I'm giving you this presentation and we will hopefully meet you um in a few weeks doing the practical course. So I've always had a love the outdoors. This probably started um in my early years as a scout. Um my first night under canvas and, and the back was cooking on outside and this led on to um being quite fortunate to go on an expedition with what used to be known as British exploring um to Greenland. So I spent six weeks, my summer holidays out there and that was my first taster of um of an expedition, an expedition life. And I knew at that point it was definitely something I wanted to continue and do more of. So I went back them on two different occasions. Um Svalbard, first time as an assistant leader. Um And the au pair is the chief leader, like to refer to me as a bit of a jack of all trades and the second time as their base cap manager, which required quite a lot of prep before heading off on the expedition. Um We were about a team of 60 on that trip and uh gave me a really good practical insights, the logistics that go into such an expedition, uh namely the food. Um But there was obviously the kit and the fuel and all the other kind of considerations as well. And so I've been able to incorporate that into kind of what I do now. Um And from there, I kind of started to went away with World Challenge as one of their leaders. Um But that was to, to Borneo to their jungles. Um And quite quickly realized I'm definitely more of a uh a cold weather um uh adventurer rather than um the jungles and all the bugs and the humidity. Um So I, I've not made it back to the jungle yet. Um And I've also been up to uh I've been done a climbing expedition in the Himalayas. And uh more recently, I've done ski expeditions in Arctic Norway. Um But during all of that time, I also realized that I really love running. Uh that's definitely become my default, keeping me fit and sane. Um and I just kind of up and up and up a bit for Gump. Gump like. And um one day found myself um in the middle of the desert doing the marathon day s so still not sure how that happened. But um I did live to tell the tale and would thoroughly recommend um doing a multiday race to anyone uh throughout all, all of that time though. Um I had been doing my academic studies and my undergrad was in sports biomedicine, which I was really enjoying. I love the human physiology. I love learning about how the body adapts to different environments and conditions and under different circumstances. Uh never ceases to amaze me. Uh But within that, I realized, you know, I needed to specialize in something and it was the nutrition angle that really kind of um caught my interest. So I carried on to, to train as a clinical dietician and that's what I did for about nine years uh working in the NHS and starting off doing more sort of nutrition support on medical surgical boards, intensive care and then uh start to specialize a bit more in children's nutrition. Um Those who are faltering growth, uh allergy management, diabetes, uh gut problems and uh and eating disorders as well. And throughout all of that time, uh whilst I was undertaking my own sort of challenges and adventures, um I realized that I wanted to learn a bit more about um how I could adapt my own nutrition for doing these trips. Um And perform better. So I did some further study in sports nutrition and that's where I started to do a bit more freelance work, working with individuals and teams and organizations, um, and covering a whole array of things, whether it be a presentation or, um, doing some educational sessions on training camps, uh, writing articles for nutrition magazines and, um, other sports journals. And also, um, working with anyone who was doing anything endurance really, whether it be, you know, a multiday uh running race or whether it be running across the Atlantic or um doing a team expedition. Um And I suppose the, my, my latest kind of um work has been with the ice maiden team, which was an all female team crossed Antarctica back in 2018. Um And the reason I mentioned them is because um they, I had several years to do a lot of assessment and training with them and it allowed me to give them a very bespoke uh nutrition plan and, and have full control over their rations whilst they're away and um whilst they're not to undersell their achievements of crossing Antarctica and, and in a pretty good time as well, but they finished in uh in pretty optimal physical condition, um which is pretty unheard of for polar explorers doing this sort of undertaking. They inevitably come back incredibly malnourished and it almost seems like a right passage, you know, the more emaciated and um unwell looking uh you are the more you've achieved. Um So they really proved that that doesn't have to be the case. Um Although they were quite upset with me because it meant that they'd only lost the weight that they put on for the trip and couldn't uh then have cake for breakfast, which I think was one of the things they were looking forward to at the end of the trip. Um, so uh endurance kind of nutrition has become sort of my uh specialism and, and it is why I've kind of got on board with the Endeavor faculty to, to deliver this to you. Uh But enough about me, unfortunately, we can't do introductions like we usually would in a, in a, in a lecture. Um but I will meet you all um in due course and we can, uh we can find out more about you and your background and your interests. This presentation has been designed to give you a background and a real kind of snapshot of um expedition nutrition. Um I do not expect by the end of this presentation or by the end of the course with the practical elements um that you will be budding nutritionists. That's not what this is about. People can spend, do whole degrees in nutrition and then still specialize in this area. But what I would hope is that you will get an insight into the importance of nutrition and that um as medics, um there are some fundamental elements that are very useful for you to understand, to then be able to help support the individuals or teams that you might be working with. Um So by the end of this presentation, I would hope that we've covered um why nutrition is important. Um a bit about the nutritional considerations for expeditions. And I'm going to be focusing more on the altitude side and the cold side because that's what this course is covering. Uh We'll also look sort of the planning um of expeditions and how we need to kind of factor in the nutrition side of things. Um And within that, that's also the logistics which can be a really big part of uh of making sure that an individual or a team achieve what they're, what they're setting out to do. So, in order to understand why expedition nutrition is important, we probably need to take a step back and have a little think about what expedition nutrition actually is. So, in the context of nutrition, uh there are a number of factors to take into account um namely your macronutrients. So these would be your carbohydrate fat and protein needs. We also need to think about fluid needs and and then our micronutrients. So our vitamins and minerals that make sure everything kind of works properly in our bodies at the right time. Um And in order to work out someone's individual nutritional needs, uh there are things that uh we need to take into account. Um Some of those are things we can't um control or manipulate. So that would be age and gender. And then um we also need to think about um body mass uh but more specifically lean body mass. Um So are muscles and connective tissues. Um And then uh we would also think about how active is that person. Um And what kind of activity they're doing, which would help determine kind of our overall kind of energy needs. Um So all of those would be worked out on an individual basis. It's probably a good time for you to have a little think about why you think uh nutrition is important in an expedition context. Um So maybe jot down a few ideas, um These can be based on your own experiences or things that you've seen in practice things you read about, um, things you googled. Um There are so many um different theories, thoughts um about uh nutrition as a whole. And um, it's probably one of the, um, one of the key areas that creates an awful lot of debate um amongst professionals as well as those who are not so professional. Um And uh and there's definitely a lot of mixed messages and myths out there. So, um, I would encourage you to write down any thoughts um about this and, um, I probably won't cover them all in this presentation, but, um, these are areas that we can certainly discuss. Um, when we, when we meet in a few weeks time. And certainly I find from experience that it's much easier to have these conversations in person and um and discussions as well. Um But the two kind of key areas that I think as medics as expedition medics, um which would be useful for you to have a better understanding of um of why, why it's important um are firstly the performance side of things. So um in order to kind of have a much better grasp on this, you need to understand what the objectives of the expedition are. Um For example, if you're supporting someone who is trying to do some sort of speed record to the South Pole um versus uh supporting a scientific exploratory um expedition um or even a high, a high altitude expedition. Um the objectives or the needs of the individual team uh will vary massively. Um So, understanding that will give you an idea of what those needs might be and then how you can support the team in that uh fatigue. I think we can all, we've all got our own examples of how fatigue can negatively impact on our performance, whether it be day to day living, uh whether it be um academically or performing at work, um our own sort of um training or sporting um objectives. So, fatigue is something that um particularly on endurance type um expeditions um can have a massive, can make a massive difference. Um on meeting the needs or the objectives, but also um on the health of the um the individuals um and nutrition can um can play a big part in minimizing fatigue if you get it right. Uh And then the other thing that can have a massive impact on performance is, is mood because of the um connection it has with motivation. So, you know, if you're, if you get up and you're feeling super sprightly and you've been fed properly, um You're more motivated to, to, to set out and do what you need to do, vice versa if you wake up and um you're feeling a bit glum or it's a particularly cloudy day or the weather is awful. Um You might be less to kind of get up and even do those very simple tasks. Um I might just want to slob around on the sofa rather than get up and do the work you need to do. And then if you put this in the context of a, of an expedition in a quite extreme environment, um that can have quite detrimental impacts on the performance of the team, but food can also be used to improve the mood. And so I know that, you know, I've had really good feedback when I've been supporting individuals doing multiday endurance races and I've made their um food packs up for them, um and uh backpack them so that they can't actually get into until the day themselves and by sneaking in little pack of Haribo or mini eggs, um, that's what's made the difference on that particular day. Um, so it might have started off being a particularly hard physical day and, um, they've ended up finishing, uh, in a much better time than they thought it would purely because of a teeny tiny packet of, um, which would not have made a big impact on their energy intake. But, um, but just purely from that morale point of view and then their mood and motivation. Mhm So the second area, uh key area that I think we need to focus on is health. Now, this is an area that hopefully should become uh we should be a little more familiar to you. Um But I'm just gonna highlight uh the areas where nutrition um or the nutritional considerations are super important. Um So there's quite a difference between optimizing someone's nutritional intake and preventing malnutrition. So if we think back to the nineties, when Seranna fines and Mike Stroud um crossed Antarctica, um you know that unbelievable feat of endurance, um something that hadn't been done before and they finished incredibly emaciated and, and malnourished and for years that has been the what appears to be the gold standard of polar explorers almost very accepting that if you are going to undertake an event such as that or a challenge such as that, that you were going to end up in a very uh unhealthy physical state more recently. Um And this is, you know, with a, a much better understanding of nutritional requirements in these extreme environments, but also being able to adapt um sports nutrition techniques and putting sort of research into practice. And certainly the work I did with the ice made an expedition um and being able to, you know, I spent years working with them to understand what their nutritional needs were and then optimizing it in a very realistic and practical way. So when they finished um crossing Antarctica, not only did they do it in a, in a very um in a very good time, better than they planned to do. Um And so we very much met the expedition of objectives, but they finished in very good physical condition. Uh much to the um upset of the team who were hoping that they were going to have cake for breakfast for the next month. Um And in order to put the weight back on, but in fact, they only lost the weight that they um purposely put on for the expedition. Uh So, you know, we have been able to kind of show that by optimizing nutrition is extreme environments, you can actually optimize health as well and prevent people from getting very unwell or injured. And there are plenty of papers that have been uh published since. And if anyone would like further information, I'm more than happy to kind of share that with you. Um some of the areas which are a bit more key on expedition. So, hyperglycemia can be a real problem. Um In nondiabetics doing these sort of um endurance feats. Um namely if you, if your energy needs um exceed what you're able to put in your tank uh and fuel it properly. Um One of the things that you are going to find is that people's blood sugars will run low. Um and if someone kind of, um if this is done over a prolonged period, then they can adapt to it and they're not necessarily very symptomatic. But if it's done very acutely, then they are going to feel the effects of that, even if it's not a clinical um hypo with a blood sugar less than four. So it's important to really know the people that you're working with, know how they behave and they react. And so if you notice someone's behavior changing or they're really slowing down and they're not performing as well as they normally would be. Um This would be one of the things that you want to be checking early on uh to make sure that they're not running a little on the low side. Um and things like, um if they, for some reason are working a bit harder that day, um or the grade has changed. So it means that they're, you know, working that bit harder by having to go uphill or if there are altitude, um that increases like your carbohydrate needs because your body is working a lot more anaerobically until it has acclimatized properly. Um Then these are all the sorts of things that can increase requirements without very subtly without realizing it. Um So we want to be preventing that and, and fundamentally to do that, you need to be meeting or close to meeting someone's carbohydrate intake. Um Another kind of area to consider is the immune response. So a little bit of exercise. So the of daily physical activity guidelines that we have that can help promote um good immunity. But when we start kind of um really pushing the boundaries and doing heavy training or um spending, you know, all day out, um running, pulling puls, uh climbing, um then these can actually have a negative impact on our, our immune response. Um and certainly being altitude with the dry air. Um and if we are exercising for more than 90 minutes, doing fairly moderate to high intensity, then we have an increased risk of upper respiratory tract infections as well. Um sort of day in day out um endurance type exercise in, in these environments um can also lead to chronic inflammation. Um and that in itself will have a um a sort of a dampening down of our immune system. So anything we can do um to help optimize that um is a good thing. Um So, number one, we need to meet our carbohydrate needs, that's key for keeping a healthy immune system. Um, but also, uh sometimes we can help prepare the gut, uh which is our main immune organ in our body. Um So things like, um, probiotics um, before going away and then even thinking about using prebiotics during the trip, um, if probiotics are not um feasible or practical something as medics, um we should all be doing is actually screening the people that we're going to be going away with. And, um, this can be, um, easier said than done at times. Um, because you're going to very much rely on people being forthcoming and giving you that information and sometimes they might not have a diagnosed health condition that they are aware of and it might be that you're going to pick it up in that screening process. So, having the, um, the right and the most, the appropriate ways to refer as needed for further assessment, um, is something that you also need to factor into your, uh, your planning of the expedition. But certainly, um, things like if someone has diabetes, for example, you need to be thinking about how you're going to manage that. Um, and whether it's, uh, how well controlled they are and what their nutritional needs will be what they used to eating. Um, different people or people have different ways of managing their diabetes. There isn't one size that fits all. Um, the other thing to consider our gut problems. So, something that might be relatively simple and back at home, for example, um, maybe an ulcer which is, is, you know, causes a little bit of bother and a little bit of symptoms. Um, you know, it's just something that's a bit uncomfortable. You go to an extreme environment, um, like Antarctica and you're doing day after day after day, um, of sledge pulling, uh, pulp pulling and then, and that increased kind of intensity and the dampened immune system, um, that also could lead to peritonitis. And then that's a whole different thing that you're having to manage. Um, so dealing with those things and getting the medications that they might need beforehand is, is pretty paramount. Um, eating disorders is, uh, something which can be very difficult to detect. Um, but if you have any suspicions that someone might have any sort of eating disorder, um, before going away, then that is definitely something that needs to be addressed. Um, and if you feel that you do not have the resources or the, um, your own, if it exceeds your kind of skill level, then, um, you definitely want to be calling in, um, people who do specialize in assessing and then advising and treating as appropriate. Um, because the last thing you want is, um, someone with anorexia nervosa, um, to be coming out on your expedition and you're in the middle or you're halfway up Everest and they've not been eating properly and they collapse and you then have to have a medical emergency to evacuate them off that mountain. Um, the other, um, one area which is, um, pretty, uh, I'd say I come across as, as the most sort of common, um, health problem is anemia or iron deficiency. So, in endurance athletes, they are, uh, more prone to anemia, um, generally, or, or just iron deficiency. Uh, and there's a lot of reasons for that. Uh, one, it can be not having the most, uh, having the most sort of optimized diet in the first place. Um, endurance in particular, uh, can be very risky in the sense of, uh, increased sweat losses and, um, a sort of a slightly traumatized gut and increases kind of, um, blood loss that way. Um, and then if you've got any vegetarian or vegan people that you're working with, that can mean meeting their kind of iron, iron needs, uh, a little more tricky. So it can be a sort of like a catalog of errors and, and lead to sort of perfect storm for, um, being a bit iron deficient or anemic. Um, and when I say iron deficient, what I mean is, um, they can have low ferritin stores. So even, you know, like, um, low end of normal, so 25 to 35 or MS per liter, um, someone so they, their hemoglobin is fine. Um, but they can be very symptomatic of that. Um, and, uh, that sort of feeds back into what we were talking about. Um fatigue and being chronically tired and not having the energy to get up and do what you need to do and focus. Um And whether it be iron deficiency or full blown anemia, this takes quite some time to correct through diet or supplementation or both. And so it definitely needs to be um picked up and addressed and treated uh way before um getting out into these more extreme environments. There are a number of nutritional considerations for exhibitions and I touched on um just sort of the basics earlier. Um So the first thing I'm gonna talk about is fueling correctly. So at any given time, your body is using a mixture of carbohydrate and fat to fuel whatever it is that uh you're doing uh our bodies unfortunately don't store carb very well, whereas they store fat incredibly well. Um So even if you've optimized your carbohydrate stores, your glycogen stores in your muscles and your liver, and this is where you, you've probably heard of um people carbohydrate loading before marathons. Um You still only have about an hour and a half to two hours um of high, high energy sort of fuel source by doing that, which is why you still need to um be able to have a carbohydrate intake when you're doing events like that. Um And there's quite a lot of um guidance now on this. Um And certainly they are guidelines but um and they can be, you know, used you need to adapt them individually. But as a starting point, um you know, if you're doing endurance type exercise, uh and most of the things that you would be covering um in a, in a cold or the high altitude environment would be um deemed endurance type events. Your carbohydrate needs are gonna be between eight and 12 g per kilo body mass per day. Um I will go into what this actually looks like um in a bit more detail in further slides. So don't worry too much at the moment, but um you could um as a little bit of an exercise, um work out your own kind of needs um based on these kind of uh requirements. Um and we should be getting a uh a mixture of different types of carbohydrate sources. So your complex carbohydrates, these are your slower release type carbohydrates. So your breads, pasta, rice cereals and if we have the more whole grain varieties that have still got, you know, quite a lot of fiber in them that's going to slow down um the release even further and is, you know, a good source of fiber so much better for us. Whereas your short acting carbohydrates um are, as they sort of say on the tin. So they're the, they're the kind of carbohydrates that are gonna get into your bloodstream much quicker and bring those blood sugar levels up and be available for energy to be used for energy. Um So these would be things like your glucose, sucrose and fructose. So, in the form of fruit or jelly sweets, um, fruit juice, sports drinks gels, that sort of thing. Um, in the real world though, we very rarely have one or the other. There's usually we were having a mixture of the two. but going back to, if you had someone who was, um, a little or certainly symptomatic of uh, lower blood sugars, then you want to be getting a short acting, um, source of carbohydrate into them, followed by a more complex um, source to prevent those blood sugars dipping again. Uh And the reasons why, you know, our body might choose a bit more carbohydrate versus fat would be if we're doing high intensity type exercise, the longer the endurance type exercise. Um If we were exercising in the heat, um, altitude can also increase our carbohydrate needs. Um, because we're working maybe a bit more anaerobically. Um So these are all things to kind of think about. Um, and there's a lot of, um, carbs still get a very bad press. Um But I think the, the one thing that's very rarely discussed is that if you are using that carbohydrate for fuel, um, then your body is not going to uh need to store it. Um, you know, in a detrimental way to your health. And, um, and so it's really important that we do actually meet those carbohydrate needs when we are exercising or doing endurance type events, which arguably any sort of um uh polar or high altitude type expedition uh will involve um the fat side of things. We don't need to worry too much about that. These sort of recommendation that we have 20 to 25% of our daily calorie needs in the form of, of fat, um, is one quite easy to, to do, but also that's more for health reasons. So the fat side of things is something that we can manipulate a little bit um in order to meet our carbohydrate needs. Um and bearing in mind that because our bodies do store um fat particularly well, when we are working at lower intensities and our body is preferring to use fat, it can dip into that and use that quite effectively. So they're not, it's not getting the, the direct energy from what we're eating um per se. So we have a bit more of a buffer than, than for example, our carbohydrate stores. Um And um with that in mind, if someone is going to be doing some sort of um uh polar expedition or, or even high altitude expedition, um the body fat stores is something that can be optimized. Um And has been something that I has been very effective. So uh sort of bulking up um although we need to be specific about that, actually getting fat um is what needs to happen so that they have that reserve to, to, to fall back on when they need it. Um, because more times than not, it's very difficult to meet someone's total calorie or energy needs when they're doing these sorts of, um, high energy, high endurance events. Um, and so if you can optimize those body fat stores, um, that's another energy reserve that they have. Yes. So, along with our fuel needs, we also need to consider our recovery needs, um, particularly on an endurance expedition where um we're going to be exercising day in day out. And um our bodies and more specifically, our muscles need to be able to repair um in order to prevent injury, um prevent fatigue and ultimately meet those um performance needs goals of the expedition. Um So in order for our bodies to be able to recover, uh in the right way, we need to be making sure that we're having optimal kind of protein intake. So for endurance type exercise, that's 1.2 to 1.5 g of protein per kilo body mass per day. And again, these are based on sports nutrition guidelines which have been extensively tried and tested. Um Protein is uh if we break it down into its building blocks, it's amino acids and we need the body needs a mixture of these amino acids um in order to, to work properly uh and different protein sources got different combinations of these amino acids. So for example, your meat sources. Oh, sorry, your your, your sources that have got more complete profile of amino acids are things like meat, fish and dairy and then your vegetarian sources. So your beans pulses and legumes. They will um they will have different combinations of these amino acids. So basically what this means is that if you're following a vegetarian diet or if you, you've got vegetarians on the team, they need to be having uh more of a mixture of protein sources in order to meet these overall protein needs. Um And so you just need to kind of think about that when planning kind of what food you're taking. Uh We also know that rather than having your protein meeting your or protein daily needs in one big dollop, like in a massive steak, um, you want to be having a regular uh intake throughout the day. Uh So again, this depends on what type of expedition you're on. If you're on where you're having like three or four meals a day, then you just want to make sure that you're having a protein source each of those. But if you are doing something more like, um crossing Antarctica where you're skiing for 10 hours a day and you're stopping only once an hour for five minutes to eat. Um, or maybe on a climbing expedition um in the Himalayas where, uh again, you'll be sort of doing more little and often uh eating. You want to make sure that, um, you've got a mixture of your carbohydrates for fuel and your protein for recovery. So, in real kind of food speak, this might uh look like uh a bag, like a munchy bag, which would have um some carbohydrate sources. So you might have some flap jack in there for your slow release carbs. You might have some sweets in there for your quick release and then you might have some nuts which would be a good protein um, source as well as some fat as well. Um, the, I think most people, you know, who do any form of exercise realize that they need to be having, um, some protein post exercise. Um, even if they don't understand the science behind it. Um, and we, we talk about the golden hour post exercise. Um, and this is, uh, ideally about 20 g of protein in, within that hour. So if you know that you can sit down within the hour and have a, a full meal, then you can meet that protein, you know, with, you know, whatever it, whatever protein source it might be that you're having with it. You know, whether it be a filet of salmon or, um, you're having a bean casserole, for example. But if you know that you're, you know, practically you're not gonna be able to sit down and eat that in the hour. Then, um, that's where having a, a sort of a drink based protein. Um, option is, is, is good, uh, ideally uh a pint of milk um meets this. Uh but on a on an expedition, um this might not be so practical. So this is where powdered forms are quite useful and practical. And most sports brands have their own version of a powdered supplement, uh sort of marketed as, as a recovery kind of drink. Um The key there is that you want to make sure there's some carbohydrate in it as well. The body uses um protein better for repair when it is in combination with some carbohydrate, it also makes it a lot more palatable. Um So you can sort of play around and have a try of all these sort of different products out there and just find ones that either you like the taste of or you, you prefer that brand for whatever reason. Um The other sort of thing to consider along with the recovery and fuel needs are your micronutrient needs. Um These are simplified in the sense that um as long as you're meeting your daily requirements set out by um sort of your uh by the Department of Health, then you don't necessarily need to be supplementing. And if you're eating quite a high energy um diet, it is more than likely you are going to be meeting these micronutrient requirements. Um Some people will take a multivitamin kind of supplement as a bit of a buffer just in case. But we do need to consider that most um nutritional supplements are quite high um dose vitamins and minerals sometimes, you know, like, you know, 10 times the amount recommended. Uh And whilst most are quite safe, uh we do need to be careful of your um fat soluble kind of vitamins. Um So, um these can, uh these can become quite um toxic if we, if we're sort of combining a lot of supplements. So it's just something to be mindful of. Um, the one, the other thing I suppose to bear in mind is that if you're not getting a lot of fresh food on expedition, um, this might be where you want to think about um, a daily multivitamin um for the duration of the expedition. But, and also again, how long it is your um uh water soluble vitamins, you know, you want to be making sure that there, you're having those on a more frequent basis. Whereas even um, a sort of suboptimal diet, you've probably got a couple of months worth of reserves before they, you're gonna start, become deficient in these vitamins and minerals. Um The one that, um, I would kind of highlight and we've already touched on, on why this might be with those who are prone to anemia or iron deficiency. So, you absolutely want to make sure that your, the people you're working with are meeting their iron requirements. Um So one is the screening beforehand to make sure, so you can correct any deficiencies that they might have before going away. Um But two is to make sure that uh, what they are eating has got good iron sources. Um Again, most of the things, if you are using any form of supplements like, um, recovery drinks or uh some foods that are naturally fortified with iron. So a lot of cereals ready bre, that sort of thing are, are fortified with iron. So that can be just a, a bit of a buffer to make sure that um if you're choosing these sorts of food products, that there is going to be a good source of iron in those. Uh and the on the iron front as well. Some studies, again, there's a lot of variability here, but it is believed that some in some kind of insurance athletes, their iron requirements might double whilst they are doing their extensive training or for the um for the duration of the um endurance type exercise. So that is something to bear in mind um when looking into good iron sources. So I realize those last few slidess have got a lot of numbers um on them and it might seem a little bamboozling if you've never looked at nutrition in this sort of detail before. So this slide is just a working example to try and give you that overview of um what it would look like calorie wise and weight wise. Um In order to really understand this slide, I suppose you need to um just appreciate that uh the different macronutrients do release different amounts of energy in the form of calories or kilo calories uh to be more precise. So, carbohydrate and protein, you get four calories per gram for those. And then for your fat, you get nine calories per gram. So almost double what you would get for your carbohydrate. Um And uh this is why historically, when weight has been a real issue, particularly on like polar expeditions, um there's been a big emphasis on fat intake because if you can get the same amount of calories for half the weight, um then that's gonna make a big difference to how much your pulk weighs and then how much energy expenditure you are going to be uh e exerting. So, um but this, you know, we now because we know more about the human body and certainly under um extreme conditions, this shouldn't be the detriment of what the body actually needs. And so it's still crucial that you try and meet those carbohydrate needs as best you can even if it does weigh that little bit more. Um So for some reason, we still use 70 kg as the typical or average person. Um It's just uh you would obviously based on whatever weight, you know, the people is you're working with. But so for your average 70 kg person or polar explorer, uh you, these are kind of what they look like in calories. So this is based, so carbohydrate is based on your um 8 to 12 g per kilo per day. So that comes out 560 to 80 40 g and then you're gonna times that by four in order to get the calorie um content of that. So that is just over 2000, just over 3000 calories per day, just in carbohydrate requirements. So just looking at that, if you think about whether your calorie counter or not, um your average person is probably needing about 2000 calories a day for in total um under normal circumstances. So already you are having to have a big bulk of food intake just from carbohydrate to meet those um energy needs adding on top of that. Um We want to be making sure that we've got at least 20% of our daily calories from fat, which um I've worked out as 100 and 11 g, which is about 1000 calories a day. And so, um I was able to do that because I knew that this would be about 5000 calories a day. So if we take 20% of that, that would be 1000 calories. So I worked back the way to work out the grams of fat for that. Um with regards to protein, um this is based on the 1.2 to 1.5 g. So again, we times that by four and we get total calories as 336 to 420 per day, we add all that up together and that's looking at just under 5000 calories a day, um, and just over a kilo in weight for food. And then if you think about as an example, someone who is away on a month long expedition, uh you times again by 30 that's close to 30 kg just in food that that person would need to pull or carry transport in some sort of way. So it's just to give you a bit of an insight into leading into the planning and logistics of different types of, of trip. Now, most people um particularly if they've bulked up or fattened up for um some sort of polar altitude expedition are going to be way heavier than 70 kg. So this is the absolute minimum and, and that just again, puts into context. So if you had someone who was 80 or 90 kg, that total calorie intake or total calorie expenditure is going to be um maybe 67, even 8000. Um And certainly again, ran fines and Mike Strauss expedition showed that there were days, they were uh expending up to 10,000 calories a day. Um which is one you would not be able to carry that amount of food to meet those energy needs, but also uh you would not be able to eat that amount, that volume of food. So this is where um being realistic about what a person can actually consume in a day. And, um, and how they are going to fit all of that in is really important in, in the planning and preparation because it might be that if you estimated that they were going to be expending up to 10,000 calories a day, but they could only eat five. Where are they going to get? Those are the 5000 calories from, well, they're going to get it from their fat body fat stores. And so this is where getting fat for these sorts of trips is actually, um, part of the planning and preparation. So what does, um, what is 5000 calories actually look like in real food? If we move on to the next slide, this is where, uh this is an example kind of daily intake for, um, for someone meeting these requirements. So we've discussed, um, why and what expedition nutrition is. We've also looked at the actual nutritional considerations for expeditions a little bit about the planning, like how to work out those nutritional needs of someone. Um And so the final sort of part of the jigsaw really is the logistics because it's all well and good working out what someone needs. Um, and uh, and what kind of foods they like and um, how this is all going to work. But, um, if we can't actually get this food or carry this amount of food, um, or get access to this food, then, um, it's all a bit redundant. So, logistics is always going to be fundamental to an expedition. And it's something that as a medic um this, the earlier you get involved with this and the more you understand, the easier it will make your life when you are um out on the ground or on the ice or snow with your team or individual. Um So I've got weight considerations down there. Um This is really just recapping what we've already kind of discussed or what I've already kind of mentioned. So whether it be you're going to a cold environment, high environment or a bit of both, um Most people will generally have significant weight loss on these trips. Um And so factoring that in and trying to minimize that is really crucial. Um So whether it be that you advise them um on gaining fat mass in order to make up for that deficit whilst they're away, um or whether it be that you have a scope to have resupplies if need be. Um So that you can have higher uh higher calorie and higher weight um rations whilst you're away. Um These are all things to kind of sort of take into consideration when planning. Um I've got person versus team and this is just to remind you that everyone is individual, their nutritional needs are individual. Um And if, whether you're working with an individual or whether you're working with a team, uh you need to kind of figure out how to meet those individual needs within a team. So the things that, that might kind of um make things a bit more challenging or, or, or things you definitely need to think about is if, for example, you have someone on the team who um needs to be gluten free because they're celiac. Um now it can be very difficult to have a mishmash of different rations. Um And actually the practicalities of preparing and eating. Uh when you're aware on expedition might mean that you have to make the whole expedition gluten free in order to um ensure that that person is not having any sort of cross contamination. And then they are getting the, the, the rations that they need. Um And something like gluten is perhaps not um such a detrimental factor. There are an awful lot of gluten free options that don't necessarily need to impact on the rest of the team. However, if you have someone who um says they need to be milk free, then that um might have uh quite big repercussions for the expedition because if you are relying on freeze dried meals, most of those will have some degree of dairy uh powder in them. Um whether it be directly or potentially contaminated. And so having that conversation with the individual about why is it, you need to be milk free as in, is it a dietary choice or is it a necessity? And then if it's a necessity, what kind of symptoms do you have if you end up having milk and all those symptoms that can be managed whilst on an expedition or in fact, is that something that might mean that that person is not suitable to go on the expedition? Um So these are the kind of things to be thinking about. Um the other uh so climate, this comes down to that this kind of a big impact on um the nutritional needs of the team or the individual. And um again, we've touched on this. So um if you are going to be at altitude, um this can increase the need for carbohydrate. Um but altitude can also impact on uh appetite for example. And so thinking about food choice and what's a bit easier and more palatable to eat when you don't have a particularly good appetite or are there other things that you can think about um that might help stimulate the appetite? Um And if someone is feeling uh the effects, knock on effects and feeling nauseous, then may be using, having some ginger based products in there to help with, that might be something else to consider. Uh Likewise, when we're operating in particularly cold environments, thermal regulation is, is really key and is really tough. So, um energy requirements generally only increase in the cold um directly because of the cold if we haven't got our layering correctly and our clothing and our equipment and then shivering. So, thinking about Um Well, this is obviously about execution nutrition. Um It brings in that extra element about um uh kit clothing, layering and understanding the um the properties of different um types of material in order to optimize um thermoregulation and prevent getting colder and shivering and increasing our energy expenditure. Likewise, if we're working quite hard in a cold environment and sweating a lot um that can freeze and then cause cold injuries, not to mention, increase our fluid um losses. And meaning that we're having to work a lot harder on keeping our fluid intake. Um And if you're having to melt your snow in order to get your fluid, um it's an extra process um and can impact on, you know, your daily routine. Um So, trying to optimize your clothing, your clothing and your layering in order to prevent or minimize sweating is another thing to be um factoring in how long is your expedition going away for? You know, these can range from weeks to months. Um And that again is going to have um potential repercussions on whether you can meet the nutritional needs of the expedition over that timeframe. Um And I would suggest that the longer you, you end up going away, um It's, you know, doing a bit more prep into how many birthdays have you got whilst you're going away. Are there any other significant moments that you might like? Is it going to be Christmas? Are there other things that people might want to celebrate. And if so, having a bit of a goody bag for those sort of occasions, um and, and personalizing as much as possible because that kind of helps with morale, especially for a very long trip away. What's your supply chain going to be like, you know, are you going to literally arrive uh with everything for the duration of the expedition or are you going to be able to have resupplies um throughout? And if so, perhaps you've got a bit more scope to have a few more luxuries um and allow rations to be that little bit heavier if need be. And then finally, you know, um expeditions cost a lot of money and certainly uh the further uh and more remote you travel to, um the costs can increase significantly. So who is funding the expedition? What are the sort of um what is the scope? Is there any sponsorship opportunities? Um sort of getting as much as you can food for an expedition is probably one of the biggest costs um after the actual travel side of things. Um So the more kind of support you can get for that, um the better and again, thinking about uh I've had some people suggest that they want to cook all their own food and then um backpack it themselves and freeze dry it. Um This is a, a massive kind of undertaking and um whilst they're absolutely dead set on doing it. And they have the time and scope to do it. Brilliant, but very few people do and um uh just thinking about the safety side of things, if, if people have slightly um out there kind of ideas and suggestions for how they might be able to cut costs. So this um just to sort of summarize, I've kind of put together some top tips um to help uh recap, refresh and um and also uh bring up a few things that I've not actually mentioned yet, but I think are quite important. Um So rings top tips um for any expedition medic um with, with thinking about food nutrition. Um So your expedition logistics get, get a, get a handle on what these are going to be early on. So, you know what you've got to work with. Um And this also includes kind of the aims and the objectives of the expedition and speaking to the individual members of the team. Um If it is a team thing because you'd be amazed at how different um individuals uh thoughts on what they're going to do and what they want to achieve from it. Um And if you have got some quite conflicting views there, then you've got even more things you need to factor in and work with. Um again, early on preexpedition screening. So you understand the individual requirements of the team, um or the or the or the person. Um And that um will obviously include the health side of things and if there's anything that needs addressing or correcting and then you can do this in good time. Um So there's no nasty surprises when you're out in the middle of nowhere in quite extreme um environment. This next point, I've not touched on this yet, but um it is quite important when you're looking at the types of food, um or supplements, um free drug meals, whatever you might be using for your expedition. Um, so it can be very difficult to know if one product is better than another. Um, and this is where a lot of people have definitely come on stuck. Um, thinking that they've bought products which, um, are the best kind of calorie to weight ratio in order to keep the weight down of their pulk or their, um, sack or whatever it is that they're using to transport their food. Um, so, for example, uh, you'll have, you've got two, expedition meals. Um, and you're looking at one says it's got 800 calories and another says, got 500 calories per serving. Well, you'd look at it and you think, well, I'll go for the 800 calorie serving because there's more calories in that. And that's why I need to be trying to meet, especially if you've got at least 5000 calories you need to, to get in each day. However, if you look on the back of the packet, you'll see that there's your nutrition label, which will have um, your macronutrients and sometimes some of your micronutrients um, listed down the side and there should be two columns, one says per 100 g and one says per serving. Now, depending on the serving size that clearly is going to reflect in how many calories are in that product. So if we look at the per 100 g, um, that is the best way to do a direct comparison um between um the different macronutrients. So it might be that in those two products, the 805 100 calories, um when you compare them per 100 g, they both say that per 100 g, they've got 500 calories. It's just that the 800 calorie uh meal has got uh is a heavier weight than the 500 calorie on which has only got 100 g in it. Um I would definitely go through this in a bit more detail. Um When we do the practical session, um I think it's probably a lot easier with some visual aids and we will go through and practice different um types of foods and exhibition products. Um But that's just as a bit of a snapshot when you are looking at um whether one thing might be better than another, you should always be comparing per 100 g of product. Um My other top tip is try these things out, different brands, different companies, they can all taste quite different and the best way to try out is when you are doing the activity that you're going to be doing when you're an expedition. So, it's all well and good. Um, trying, uh, one of these meals at home. But, um, and in fact, you might think this tastes disgusting and then after, if you go out and you've skied for a day and then you have it and you're properly hungry, you'll be thinking, oh, this actually tastes quite all right now. So if you can try it out when you're, um, doing the activity that you're going to be doing, it's much more relevant and a much more reliable measure of whether you're going to like it or not. Um, I think the other thing is that, um, no matter how much you like something, make sure you have variety. Um, I remember working with a woman who, um, loved these, um, banana cereal bars, only the banana ones. And I said to her, I think you should take some different flavors with you. Um, for this week long, multi day, um, race and she was adamant. No, only like the banana one, banana ones. And, um, when she came back and we had a little debrief, um, she said that she got out and on day one, she was feeling very sick and her appetite was completely off and she took a mouthful of this banana, um, ce bar and, um, almost vomited and so she couldn't eat them for the rest of the week. So always make sure that you've got variety because you don't know what's gonna happen to your appetite and what you might, your preferences will be when you're in that environment. Um when working with um with your people um definitely try and do your own. Um I say body composition monitoring early on. So by that, um so rudimentary is uh body weight and height. Um We don't generally like to use BMI in athletes. It can uh it's not the most representative and BMI is not measuring body composition, it is literally looking at height for weight, but body weight monitoring is quite crucial during training and the build up to the expedition, especially if you are advising on gaining fat mass. Um There are certain scales that you can get um which do body composition. Um the ones that you kind of stand on or hold on and they work at your percent body fat. Um These can uh the there's different degrees of um reliability on them. Um So make sure that if you're going to use something like that, it is new, it's calibrated. Um And it's kind of um uh something that, you know, other uh either nutritionists or medics can vouch for um a lot of them are based on bi electrical impedance um and total body water. And as such, it means that hydration states can, can, can really skew the results. So whenever you're doing any sort of um body competition monitoring or just even checking weight, ideally, you want to do it first thing in the morning after that first morning pee in minimal clothing. So underwear, for example, and that will give you as a reliable um base measure as, as possible. Um I've been known to take um scales with me out on expedition um to be able to literally weigh individuals just before they leave the expedition. And then just when they come back, usually on sort of training expeditions um in order to get as accurate view as possible of um the changes that they've seen whilst away. Um But that obviously depends on uh logistics and what's what's available to you uh supplements. So, in general, um I wouldn't say, uh you know, I wouldn't generalize and say people need to have a multivitamin if um you want to be maximizing these sorts of things before they go away. And um if they're having a good varied diet and they're eating and having quite a high energy intake, they should, that should be adequate to meet their um multivitamin kind of or their, their micronutrient requirements. Um But you can also, you know, where possible request some blood work just to make sure that um there aren't any deficiencies uh particularly um on the iron side of things and bearing in mind that um you need to specifically ask for an iron profile. Um But what other than just relying on, on hemoglobin if you're gonna do that. Um And uh and yes, a probiotic before the expeditions of a daily. Um Most of the evidence is around Act and the cold, but there's an awful lot of other um probiotics out there so, has become very popular and very accessible. Um So sort of daily, daily friendly bacteria is um is not a bad plan before expedition. Um And then the final thing I've got there is um that morale prescription. Um So by this, I mean, you know, food, we all know food and mood is so interlinked. Um So knowing your people that you're going away with knowing the little things that they like, whether it be, you know, their favorite sweets or some percy pigs or they're particularly partial to um some shortbread, it doesn't matter what it is. But if you're able, if you know what that is and then you're able to accommodate for that during the expedition, um You'll get an awful lot more out of your, out of your team. Um I hope that's been of, of interest and of use. Um It really is a whistle stop tour to, um, not just expedition nutrition but nutrition as a whole. Um, we will uh have plenty of opportunity over the course of the practical week. Um So not just during the session that you'll do with me, but, um, as I said before, uh I'm sure you'll have a million and one questions about uh food and nutrition. Um So please just pick my brain as much as possible whilst we're away. And if there is anything I can't answer, um because I'm not an oracle, um then hopefully I'll be at least be able to signpost you to um other uh people or resources that will help answer your questions. Um The neck, the final slide. So these are the references I've used throughout the presentation plus a few extras just in case anyone um is particularly interested in this kind of area, I wanted um a bit of a, a bit more of an overview. Um Like I said, this has been a whistle stop um uh uh introduction to um nutrition and expedition nutrition. Um So I don't expect um it all made sense and um may well have opened up more questions than answers, but we have plenty of opportunity to discuss all this um when we meet. So until then um take care and look forward to meeting you all in a few weeks.