Footcare for Backpackers, Part 2: An Interview with AAPSM President, Paul Langer

Ryan Grayson April 7, 2014

In part one, I discussed footwear for backpackers with Paul Langer, president of the American Academy of Podiatric Sports Medicine and D.P.M. at one of the largest orthopedic groups in the country, Twin Cities Orthopedics in Minnesota. In part two, Paul answers our questions about foot care on the trail.

RG: How can a hiker prepare their feet during the weeks or months before a long distance hike?

PL: The best approach is to log lots of miles in the footwear you plan on using, obviously to not only toughen the feet but to also break in the boots or shoes.

I worked on the medical team of a 250k stage race across the Gobi desert in 2005 and saw and heard every philosophy from the athletes on how they managed their skin issues. One athlete soaked his feet every night in iodine and water. One guy claimed that he never used lotions or trimmed calluses and had not developed any blisters since doing so. Another claimed that he stopped his blister problems by trimming his calluses and using lotions to keep his skin soft and moist. This illustrates that there is not one way for everybody, but there are great tools available and people have to learn what works for them. Not surprisingly, the people we saw in the medical tent with blistered and sore feet were the less experienced athletes. They didn’t appreciate that in ultra-endurance events, especially multi-day events, it is NEVER a good idea to ignore pain and/or a potential blister developing.

What footwear do you prefer on the trail?

If we feel a hot spot starting to develop on our feet, what is the proper way to treat that?

Stop immediately and apply either moleskin or one of the slick adhesive patches (like Engo) to reduce the friction over the hot spot.

If a blister does develop, how should we be treating them? My current understanding is that unlike burn blisters, you should puncture friction blisters to drain the fluid. Is the practice of using a needle to run a length of thread through the blister and leaving it overnight to wick fluid out of the blister while you sleep recommended?

I do advocate draining blisters by puncturing them with as sterile of a needle that you can manage. Boil it in water, scrub it with iodine, or heat it in a fire (but clean carbon deposits off before puncturing). Also prep the skin over the puncture site with iodine or something similar. Puncturing is better than trimming the skin off because the top layer of the skin (the epidermis) can then serve as a "biological dressing" and minimize risk of infection.

Because blisters have a tendency to refill, I advocate puncturing multiple times and make sure at least one is at the lowest point of the blister, so that gravity can help drain through that spot when weight-bearing. I have seen the thread technique used and it appears to work well. The idea is that the thread wicks fluid out of the blister, and it can do this, but the risk is that the thread could also wick bacteria into the blister and that, of course, would be bad.

Even if we are stopping at the first signs of a hot spot, it’s still common to forget about preventative daily foot care until we already have some level of discomfort. With the abuse we put on our feet every day, what sort of daily maintenance should we be doing?

As above, experienced hikers learn through trial and error what works best for them. A few general rules of thumb include; maintaining clean, healthy skin and properly trimmed toenails. Using wicking socks and changing them if they become dirty or wet.

Sometimes removing shoes can cause problems as the feet might swell once the snug footwear is removed increasing the risk of blistering once the boot is back on and the hike resumes. A perfect place to rest and remove the boots would be next to a cold stream to wash and "ice" the feet while resting.

What should we have in our first aid kit for daily foot maintenance and minor injuries? How about the ultra-lighters who are only going to carry the bare minimum? Or put another way, what would you never go without?

Iodine or topical antibiotic and sterile adhesive bandages for going ultralight. For foot maintenance - mole skin, blister patches, skin lubricant, athletic tape, nail file and clipper.

I'd like to move onto some issues where the cause and treatment is less well-known. With long-distance hiking, a common problem is the swelling of the feet at the end of the day. How can this be prevented? Will stiffer shoes or boots help?

Footwear changes will not help. Long periods of weight-bearing activity, fluctuations in hydration status/electrolyte imbalances, some medications, varicose veins, changes in elevation and even arthritis can all contribute to swelling. I would experiment with compression stockings. Over-the-counter knee high stockings are easily found in running stores and can provide compression. If these fail to work then medically prescribed ones would be warranted. As above, icing/cold water soaks and elevation of the feet can help as well.

How about plantar fasciitis? This one is common for me and many other hikers.

There are so many causes of plantar fasciitis that there isn’t really a prevention program, but there are two things I recommend to every person affected to relieve pain. One is to do a stretch/massage of the plantar fascia (Click here to download the handout that Paul gives to his patients). One study showed that 85% of people can reduce their pain just by doing the stretch. Reducing strain on the plantar fascia can be achieved with a semi-rigid insole (not a gel or foam one), but there is also a taping technique that can be done in the field. The tape supports the arch and is very effective in reducing pain while it is in place. Watch Video of Taping Technique for Plantar Fasciitis >

Many thru-hikers have stopped their hike due to sharp shooting pain starting from the heel of their foot and going up their Achilles tendon with every step. What may be causing this and how can it be avoided?

Achilles tendonitis would be the most likely cause and is common in people over age 35, but also can be set off by uphill hiking or running due to the increased strain. The best prevention method is to do what is known as eccentric strengthening (click here for the handout also mentioned above). The exercise not only increases the strength of the calf muscles, but also increases elasticity of the Achilles tendon. I advise all of my patients to do this exercise daily regardless of their sport.

A lot of hikers, including myself, have lost feeling in our toes during a long hike. What are some likely reasons for this?

There are two common conditions that are most likely to cause numbness in the toes and some other less likely causes. These conditions can be difficult to diagnose and self-treat, so I'll offer some brief descriptions, but would encourage anyone with persistent symptoms to see a sports medicine specialist.

By far the most common cause is called a Morton's neuroma. A neuroma is a pinched, irritated and sometimes enlarged nerve between the toes. The most commonly affected toes are the 3rd and 4th toes (big toe is 1st and little toe is 5th). Many people have difficulty determining which toes are affected specifically. It can occur for a number of reasons: swelling feet, tight boots, stone bruises, and long miles uphill. For many people we do not find one specific cause.

In clinic, I treat this first with a simple metatarsal pad which distributes pressure more broadly across the forefoot. Unfortunately, most of the metatarsal pads I’ve seen in stores either are not dense enough to distribute pressure or lack adequate adhesive or durability to stay in one place and last long. I use a wool met pad with good adhesive that often lasts as long as the shoes. If met pads do not give adequate relief and the neuroma is persistently painful, we may inject it with Cortisone.

The bottom line though is that once you have a neuroma, unless it is surgically removed, you will always have it. Less than 20% of people ever need surgery for this problem, but I always emphasize that it is important to not only treat it early but make sure to never ignore persistent or recurrent numbness or pain because it will get worse and harder to treat.

The other potential cause of numbness to toes is Tarsal Tunnel Syndrome. This is similar to Carpal Tunnel Syndrome in the wrist. The nerve runs through a tunnel on the medial (or inside) of the ankle and then passes through the arch and bottom of the foot ending at the toes. Tingling, numbness or pain may be experienced anywhere from the heel to the toes with this condition. Pressure on the nerve within the tunnel may cause these symptoms. The pressure may be due to benign soft tissue growths, varicose veins or biomechanical issues such as excessive pronation. I usually start treatment with a simple taping technique called low dye taping which alters pronation and can reduce pressure within the tunnel. Watch Video of the Low Dye Taping Technique >

If a patient responds well to the tape then they may also benefit from a firm insole, which can mimic the effects of the tape. Cortisone injections would be a next line of therapy, but people rarely need surgery for this condition.

Other less common causes of toe numbness are nerve root compression at the spinal cord level. Those who have a history of low back pain may be more prone to developing pain, tingling, and/or numbness in a limb anywhere from the hips to the toes.

Peripheral neuropathy is another condition causing numbness. This is more commonly seen in diabetics, older individuals and/or those who have experienced previous episodes of frost bite.

Finally, vasospastic disorders can cause numbness as well as pain in the toes. For some people, exposure to cold and/or moisture can trigger a spasm of the small muscles that control blood flow to digits. I always consider this when patients tell me their symptoms are worse in cold conditions or after cold water crossings.

You often read about people losing their toenails during a long hike. I’ve never experienced this one myself, but what may be causing that?

Losing toenails is very common in endurance sports in general. The high repetition of hiking and running cause micro trauma that, for some, causes bleeding under the nails, which then loosens the nail and it eventually falls off.

Because feet swell during long events, shoes that cannot accommodate the increased volume will create pressure on the longest toes leading to loosening of the nail. Conversely, a shoe that is too loose in the heel and ankle can allow the foot to slide forward on long descents, which also traumatizes the nail bed. A shoe that is too narrow and/or too tapered at the toe-box will increase pressure on the 5th digit nail bed (little toe). Also, for most of us the 5th toe tends to curl in a bit as we walk a bit on the side of the nail - this can further increase the risk of nail trauma.

The toenail will ALWAYS grow back, but it may never be the same. Once the "seal" between the nail and nail bed has been broken, the nail will not likely adhere perfectly anymore. This means that a person may be vulnerable to recurrence and will also likely develop fungal changes to the nail bed. We all have fungus that lives on our foot. It is normal and natural. It is the same fungus, if it proliferates, that causes athletes foot. However, once the nail has loosened, even once, it then has the opportunity to get under the nail and cause brittleness, discoloration, etc. At this time there are not side-effect free fungal nail treatments and there is such a high recurrence rate anyway that I usually just recommend good foot hygiene.

I'd like to give a big thanks to Paul Langer for taking the time to help out the hiking community by answering our questions! If anyone has an further questions or comments, please leave them in the comments section below or visit Paul's website at PaulLangerDPM.com.

Paul R. Langer, DPM (paullangerdpm.com) is a board certified podiatrist who specializes in sports medicine, foot disorders, biomechanics, surgery and diabetic foot care. He has lectured at and served on the medical staff of international athletic events including the Boston Marathon and China’s Gobi March. He is a clinical advisor for the American Running Association, and an associate of the American College of Foot and Ankle Surgeons. He is the author of Great Feet for Life: Footcare and Footwear for Healthy Aging and has been featured in the following publications:

Athletic Footwear and Orthoses in Sports Medicine
The Big Doctors Book of Home Remedies
Breakthroughs in Drug-Free Healing
Barefoot Running Step by Step

Education: Dr. Langer received his podiatric education at Des Moines University and completed two years of residency and surgical training at the Veterans Affairs Medical Center.

Hospital Affiliations: Fairview Ridges Hospital Fairview Southdale Hospital Minnesota Valley Surgery Center University of Minnesota Medical Center - Fairview

Professional Affiliations and Memberships: American Academy of Podiatric Sports Medicine, President Foot & Ankle Quarterly, Board Member

Special Achievements and Awards: Top Doctor: Voted a top doctor by his peers in Minneapolis/St. Paul magazine (2006 - 2010)

Footcare for Backpackers, Part 1: An Interview with AAPSM President, Paul Langer

Ryan Grayson March 31, 2014

By far, the most read post on this blog is my article on hiking shoes vs. boots, so I wanted to revisit the topic with an expert’s advice. I contacted Paul Langer, president of the American Academy of Podiatric Sports Medicine and D.P.M. at one of the largest orthopedic groups in the country, Twin Cities Orthopedics in Minnesota. Paul was more than happy to answer all of my questions and those asked by fellow hikers on the WhiteBlaze.net forums.

Part one will focus on footwear for backpackers and part two will be on foot care and maintenance on the trail, although there will be some overlap. I started my questions with the subject of my previous article, shoes vs. boots.

RG: Possibly the most common footwear debate among hikers is trail runners vs. hiking boots. I prefer, and often recommend to thru-hikers, trail runners with a sturdy wide sole over boots. What are your thoughts? Do you see advantages or disadvantages to either?

PL: Footwear and comfort are highly personal and subjective topics - not just for hiking and sports, but also for daily living. As background, I worked in running shoe stores when I was a podiatry student and I couldn’t understand why people would have such different experiences with the shoes I showed them in terms of comfort.

"...shoes are like quarterbacks. They get too much credit when things are good and too much blame when things are bad."

-Paul Langer

Research on comfort seems to show that our footwear preferences are influenced by our movement patterns and sensitivity, among other things, which are highly unique person to person. Our bodies are programmed to move in the manner that uses the least amount of energy and causes the least amount of discomfort or pain. No one moves in the exact same way. Our movement pattern is as unique as our signature.

If a shoe works with our movement pattern then it will feel more comfortable. If it works against our movement pattern then it will feel uncomfortable or at least less comfortable than a "better" shoe.

There is also a hierarchy in comfort factors. For example, some people feel that cushioning is of primary importance and arch support or weight are less so. Others might place higher priority on weight and firmer feel. Neither is wrong. In working with athletes and non-athletes, I have learned that unless there is a very specific injury or source of chronic pain that can be addressed by a specific shoe, insole, or shoe modification, I encourage them to trust their instincts on what shoes have the fit and feel that they prefer for the given activity.

Most hikers know their body and feet well and know their preferences. I always respect personal footwear preferences and then try to offer the simplest changes to address pain or injuries as needed.

Out of the gate, and I'm rightfully put in my place. Although, it seems to be the conventional wisdom that hikers need boots, so I've noticed new backpackers gravitating toward them by default. Often, because of a belief that a high-collar will offer better ankle support. That seems to make sense, but in practice I don't find them to be very effective. Would ankle wraps do more to protect someone prone to ankle injuries than high-collared footwear?

Yes. Ankle wraps - especially lace-up or Velcro ones are able to provide better ankle protection than high-collared boots.

What footwear do you prefer on the trail?

Can high collars on boots actually cause injuries by restricting ankle movement and put more stress on hips and knees?

If a boot were too restrictive at the ankle it would likely cause discomfort there before affecting the hip or knee.

Is there any truth to the idea that high-collar boots hinder the development of the support structures inside the ankle?

I've never seen a study that showed high-collared boots inhibit balance or ankle strength long term. In fact, there are no studies that show ankle braces cause this either. Maybe if a person wore their high-collar boots all day, every day, they might have issues, but I would argue that a person who hikes regularly in high-collar boots probably has better balance and strength than a sedentary person who wears flat shoes all day.

Alright, I admit I may be trying to reinforce my opinion that trail runners are far superior, but I have one final question about ankle support. A hiker going by the name Trailweaver on WhiteBlaze.net, asks, "I'm now recovered from a severe fracture of the tibia-fibula, but now that ankle swells so much that it's impossible to wear boots (with ankle support) which I always wore before. How do I best protect myself from twisted ankles in low cut shoes? And what should I do about the swelling when I'm hiking?

Unfortunately, after many ankle fractures people develop arthritis. Her swelling is related to the arthritis. I would recommend wearing a compression stocking or adjustable ankle brace that is comfortable. No one can predict how much compression or ankle support is ideal for any given person, so she would need to experiment with different levels of ankle support and find what works for her. She should also be very diligent about doing ankle balance and strength exercises to minimize her risk of re-injury. (Click here to download an exercise sheet provided by Paul that covers foot and ankle exercises)

On a long hike, minimizing swelling early is important because once it starts it can be hard to reduce. On the trail, taking advantage of cold streams can help. Elevating the foot when resting is beneficial as well.

"I look at footwear as tools and I select the best tool for the given conditions of the trail and how my feet or legs feel."

-Paul Langer

How are knee and hip pain related to improper footwear and how can we prevent some of these issues down the trail?

The term "improper footwear" is a controversial one. There is no formal definition and many philosophies on the term. For those with knee or hip pain, I would focus on those joints and then functional movement patterns and core strength, which are more likely contributing to pain than shoes. I've said often, especially in relation to knee, hip, and leg injuries, that shoes are like quarterbacks. They get too much credit when things are good and too much blame when things are bad.

It's common practice for long-distance hikers to purchase shoes that are one size larger than you need to accommodate the foot growth that happens on a long-distance hike. Is that good advice to follow? Is this perceived foot growth due to bones growing, arches collapsing, soft tissue swelling, or something else?

There is evidence that cultures who go barefoot or wear only sandals have wider and longer feet in relation to body size, but for thru-hikers it would be unlikely that their feet could grow or expand while wearing footwear that minimizes expansion of bones/joints/soft tissue.

Any perceived change in foot size would be most likely due to soft tissue edema (swelling). If this happens then it would be expected that the feet would return to previous size within a few days or weeks of completing the hike. I haven’t actually seen any research specifically on thru-hikers and foot size, but it would be interesting if we had some data.

I do recommend fitting the boots bigger to accommodate swelling, but not too big. One to 1.5 sizes bigger than street shoes should suffice for most people. In general, I recommend that the boot be snug in the heel and mid-foot to minimize pistoning of the heel and forward slipping on downhills. The boot should allow for wiggle room in the toes to accommodate the swelling. So basically, the boot should be snug in the back two-thirds.

HeartFire from WhiteBlaze has a question about insoles. "Do rigid insoles shift your posture or spine?" She said that within 100 miles of switching to rigid Superfeet insoles, she experienced knee pain, shoulder pain, and back pain. When she got rid of them, the problems went away.

For me personally, Superfeet worked great. I started my first long distance hike with minimalist shoes and regretted it after about 400 miles ($1000 x-ray and emergency room visit). On doctor's orders, I switched to a stiffer shoe with rigid Superfeet insoles and my feet improved significantly after only a couple weeks. Are softer insoles better than rigid or is it as subjective as “proper” footwear?

This a very big topic and source of confusion, not just in hiking, but in sports medicine in general. What I always keep in mind, as I mentioned above, is that individual movement patterns are highly unique. In addition, people do not respond in systematic ways to biomechanical interventions. What this means is that prescribing insoles or orthotics (or footwear for that matter) is not like prescribing antibiotics, for example. I can prescribe the same antibiotic to 10 people and expect consistent results in their infection with small variations in side effects. But I can prescribe an insole or orthotic for, let’s say, 10 people with plantar fasciitis and similar foot types and I might get 10 different responses in terms of comfort, pain relief or potential side effects. I explain this to every patient who I speak to about shoes, insoles or orthotics.

My general approach is to do as little as possible to negatively affect their preferred movement pattern, but the problem is that we do not know how a given person will respond, ever. There has been much research done on this topic, which shows that approximately 70% of people respond positively to insoles and orthotics. We do not understand why and the reasons would probably be different person to person anyway.

Benno Nigg, PhD, one of the foremost footwear researchers has said that there is probably an ideal amount of cushioning for each of us in terms of footwear. We just don’t yet know how to determine what that might be. I rarely recommend cushioned insoles for most foot conditions except for older patients who have lost the natural fat pad on the bottom of the foot. For athletes and hikers, semi-rigid insoles like Powerstep, Superfeet and others are better at distributing foot pressure, supporting the arch and being durable enough to hold up.

Many backpackers are switching to minimalist footwear. As a barefoot runner and someone injured on the trail due to minimalist footwear, I’d like to know your opinion on this topic. Is it good or bad for the foot? Are there pros and cons?

This is a huge topic. I'll preface this by saying that I run in Vibram FiveFingers, New Balance Minimus, Merrel Trail Gloves, and other minimalist footwear, but I also wear conventional shoes and occasionally insoles and orthotics. I look at footwear as tools and I select the best tool for the given conditions of the trail and how my feet or legs feel. I run more than I hike and I'm lucky enough to live along the Mississippi River, so have miles of grass and parkland right outside my front door.

I love my VFF's for grass runs of up to 8 miles. I probably could condition myself to go longer than that in them but don’t feel the need. For long runs or speed workouts, I use my conventional shoes because I tend to get a bit more beat up. On rocky surfaces or if I'm sore from the previous day's workout, I will also use a more structured shoe or my insoles/orthotics. I spent three years transitioning to VFF's and at one point used them for 50% of my mileage.

Okay, enough about me. I have treated many athletes who have hurt themselves trying barefoot or minimalist shoes. What I find, as far as mistakes made with minimalist shoes, is that people assume that the impact forces of running or hiking magically disappear. They do not - they are merely redistributed. So while knee and hip loading may be decreased, the loads on the calf muscles, Achilles tendons, and metatarsals (long skinny bones of the foot) are increased. This is a big change for most of us who have been using conventional shoes for all of our lives.

Anyone who is interested in trying them needs to do so gradually, listen to their body's feedback and never ignore pain. I give my patients exercises to do to increase strength and flexibility of the calf and Achilles prior to starting (download Paul's exercise pamphlet here). Personally, on very rocky terrain and especially with a pack on my back, I would not likely use my minimalist shoes. I would never say nobody should backpack in minimalist shoes, but I would strongly emphasize a very smart, safe and gradual build up to it - likely over the course of many months or years.

One more question about minimalist footwear and I'll move on to the topic of foot maintenance and care on the trail. A minimalist footwear hiker named Meriadoc, from WhiteBlaze.net, has a question about zero drop shoes. "Why are some manufacturers going with a 4 to 5 mm drop in their minimalist shoes?"

He also asks, "When I go on the trail if I push too hard my Achilles starts to ache with a dull pain that gradually increases until it forces me to stop. Why would this happen? Shouldn't my Achilles already be at the full length from walking and hiking in zero drop shoes every day? Is it similar to overuse injuries in the knee tendons?"

The pre-activation and loading of the calf muscles and Achilles tendon complex is higher in shoes with zero drop. Higher heel heights decrease this load. Because we have been using elevated heel design shoes for decades, our bodies need to adapt to the altered load. I don’t know how old Meriadoc is, but if he is over 35 then he is already prone to Achilles tendonopathy because of age related changes to the tendons. He should be doing the eccentric calf muscle exercises I mention above to improve strength and elasticity of the tendon and maybe until he resolves the issue stick to shoes with 4-10 mm of heel elevation. How long should it take to adapt to zero drop? No one can answer that question. It would be highly unique to each individual.

In part two, Paul will answer our questions about how to take care of our feet on the trail, and the causes and solutions to many common foot issues.

Related article:
Footcare for Backpackers, Part 2
Should I Buy Hiking Shoes or Boots?

Grocery Shopping with a Thru-hiker, Part 2

Ryan Grayson March 17, 2014

A Thru-Hiker Shopping List

In part one, I wrote about the features of the best backpacking foods (calorie dense, easy to prepare, nutritious, non-perishable, appetizing, inexpensive, and versatile). Below are common items on my resupply shopping list that take all of that into account with more nutrition advice from New Orleans Saints sports dietitian, Tavis Piattoly.

Obviously, taste is too subjective to tell you specifically what to buy, so my goal instead is to give you new things to consider when buying food. It's inevitable that I will miss something, so please share your own suggestions in the comments below.

Olive Oil

Oil is all fat, so it's the most calorie dense thing you can pack (about 242 calories per ounce). By adding olive oil to pasta, potatoes, rice, beans, etc, you can increase all of their calorie density. Instant potatoes, for example, have about 111 calories per ounce, but has 176 if you mix in two tablespoons of olive oil.

That brings up an important point: If you need 6,000 calories per day, and your meals average 110 calories per ounce (the average number of calories in freeze-dried pasta meals and instant potatoes), you'd need 3.5 pounds of food per day. If you instead carry meals that average 150 calories per ounce, you will reduce your food weight by 1 pound for every day's worth of food in your pack.

There are lots of oils to choose from, but olive oil has a nice buttery flavor, it's easy to find in resupply towns, and it's cheap (as low as US$0.99 per 1,000 calories), which brings up another important point: If you want to do a long distance hike on a budget, think of the cost of food per calorie, not the shelf price or the price per meal.

Another benefit to olive oil is that it's nearly 75% monounsaturated fatty acids, which is a healthy dietary fat. It also contains Omega-3 Fatty Acids, which help reduce joint and muscle inflammation.

One more thing, even if you can find the small plastic bottles of olive oil, I found that an empty soda bottle works better to prevent leaking.

Instant Potatoes

Instant mashed potatoes taste good and cook quickly, but nutritionally they're not great. Their glycemic index (GI) is higher than table sugar. I put them high on this list, however, to talk about blood sugar spikes from consuming a high GI diet.

In the morning, and during the day while hiking, high GI foods will provide you with an immediate source of energy, but pair that with fats, protein, and fiber:

"Adding fat or protein to any high glycemic carbohydrate source will blunt the spike in blood sugar," says Tavis Piattoly, MS, RD, LDN and Sports Dietitian and Nutrition Consultant for the New Orleans Saints. "I wouldn't recommend high GI foods while you are resting (before bed or during any period of inactivity) as your blood sugar could drop quickly and a hiker could experience fatigue. It would be best to have a meal mixed with protein, carbs, and fat to keep blood sugar in check."

For example, when eating a high GI food like instant potatoes, mix in olive oil and bacon bits to add fat and protein to help blunt the spike in blood sugar. Add a side like peanut butter on whole-wheat bread or tortilla for additional fiber, fat, and protein.

Nuts

Some of the best backpacking foods are nuts and seeds. Macadamia Nuts and Pecans pack about 200 calories per ounce. Most other nuts average about 185 and peanuts have about 150 calories per ounce (Peanuts are higher in protein, however, and considerably cheaper). Nuts are also versatile, since most are great mixed with oatmeal, trail mixes, or eaten plain.

My favorite are walnuts. They offer a good balance of calories and protein per ounce. They are not the best in those categories, but a good average in both. What really makes them my top choice are their high levels of Omega-3 fatty acids, which can reduce muscle and joint inflammation. No other nut has more.

Peanuts are my second choice for cost, taste, and protein per ounce, but eating a variety of nuts and seeds is always a better choice.

Here is a comparison of commonly available nuts in a variety of categories:

Nut	Calories / oz	Protein / oz	Cost / 1000 cal.	Omega-3
Walnuts	189	4.72	$2.99	2.50 g
Macadamia Nuts	213	2.02	$3.94	0
Peanuts	152	6.07	$1.46	0
Almonds	172	6.07	$1.83	0
Pecans	200	2.83	$2.88	0.29 g
Cashews	162	5.06	$2.45	0
Mixed Nuts	172	6.07	$1.95	-

Peanut Butter

My favorite backpacking food is peanut butter. It has a lot of calories per ounce (about 169), it keeps for a very long time, and it is one of the cheapest foods per calorie (as low as 88¢ per 1,000). It's also a great substitute for meat protein, which can be limited on the trail.

Perhaps the best thing about it as a backpacking food is its versatility. Slather some on a tortilla, bread, or crackers, make a peanut butter sauce for pasta (see recipes in part 3), add it to oatmeal to increase protein in your breakfast, or just eat a big spoonful with any meal or snack for extra fat, protein, and calories.

It’s tempting to buy powdered peanut butter (like PB2) to save weight, but it has almost 40% fewer calories per ounce, so it's actually heavier. It also costs nearly twice as much, is less nutritious, and in my opinion tastes absolutely terrible. It should be ashamed to call itself peanut butter.

Tortillas, Breads and Crackers

Unlike bread or crackers, whole wheat tortillas can take a lot of abuse when stowed in a backpack. Per calorie, however, tortillas cost about twice as much. Cheaper bread alternatives that can take more abuse are bagels, pita bread, and English muffins. (Campfire English muffin pizzas are amazing on the trail, by the way, more on that in part 3.)

If you want more calories per ounce, consider whole wheat Ritz crackers with your peanut butter, tuna, meats, or cheeses. They have twice as much as bread and tortillas.

Always go with whole wheat when possible to get all the fiber you can get:

"I typically recommend trying to get 10 g [of fiber] for every 1000 calories consumed," said Tavis. "The importance and benefits for a hiker would be to help regulate blood sugar and keep you full longer. The more stable your blood sugar and insulin levels are, the more energy you should have throughout the day. A more stable carbohydrate [from whole grains] will be better utilized as an energy source and keep you more full during a long day of activity."

Whole Wheat Pasta

It’s tempting to go with cheap ramen noodles or Knorr Pasta Sides (and sometimes I still do), but with regular whole wheat pasta you can improve your diet without adding to your food budget. Unlike ramen noodles and many prepackaged pasta meals, whole wheat pasta is high in fiber and protein, it has a lower glycemic index, and it has no saturated fat. Diets high in saturated fat can lead to sluggishness and inflammation.

Whole Wheat Pasta is also versatile and, with only slightly more effort, you can make some meals every bit as good as a freeze-dried Mountain House meal, which will weigh less per calorie and at a fraction of the cost.

Save fuel by purchasing thinner pastas, like angel hair pasta or mini rotini, which cook much faster (al dente in about 4-7 minutes, 30-50% faster than regular spaghetti). Also, cooking it al dente, so it's still firm when bitten, has the added benefit of slowing digestion, which levels out the spike in blood sugar and makes you feel fuller longer.

My last pasta tip, you don't need a giant pot of boiling water to cook pasta. This of course wastes fuel and would be impractical in a small backpacker cook pot. Instead, fill your pot with enough water to cover the pasta and stir regularly, especially in the first minute or two when the sticky starches are at a high concentration on the surface of the pasta. Your pasta will cook just as well as if you had a large pot of boiling water and without clumping. After the pasta is finished boiling, save that starchy water to use in sauces to make them thicker and creamier.

Cheeses

Unlike soft cheeses, hard block cheeses like Parmesan and Romano do not need to be refrigerated. They can last for several days if sealed and if temperatures do not exceed 85°F.

Other reasons to carry Parmesan is that it has 11 g of protein per ounce. That's more than nuts, peanut butter, powdered milk, and non-dehydrated meats. It can be added to prepackaged pasta dishes or used with whole wheat pasta and olive oil to make Parmesan Noodles.

Softer cheeses, when individually sealed, can keep for a few days if it isn't too hot. String cheese, in particular, packs well. On a warm day, keep cheese in the center of your pack to keep it cool.

Mac and Cheese

Skip the box of Kraft Macaroni and cheese and make it from scratch using versatile ingredients that can be used in multiple ways. Just cook your pasta, add powdered whole milk, olive oil, and melt in shredded cheese or block cheese that has been shredded or cut into tiny pieces.

Another reason I suggest versatile ingredients such as these, is because the more ways you use them the larger quantities you can buy, which will save you money on a long distance hike.

Oatmeal

Oatmeal also has a high glycemic index and instant oatmeal, although convenient, is loaded with additional sugar. Plain rolled oats are often less expensive per calorie and can be prepared in a number of healthier ways.

Reduce the overall glycemic index of the meal by adding nuts, peanut butter, whey protein, and/or powdered milk. You can also add a little olive oil or butter (if it's cold enough to carry butter) to increase the calories and improve flavor. Oatmeal can also be mixed with dried fruit or cocoa mixes such as Nestle or Ovaltine. It's great with a freshly chopped apple or fresh picked berries too.

In the photo of my oatmeal above, I added walnuts, peanut butter, blueberries,and protein powder for a 1,000 calorie breakfast with about 30g of protein 80g of carbs, and 35g of fat.

Dried Fruit

Dried fruit is not calorie dense, but a variety of dried fruit will prevent some vitamin deficiencies on your thru-hike. Not only are they a convenient quick snack, but many dried fruits are great in oatmeal, trail mixes, and when used to sweeten certain rice and pasta dishes.

Tart cherries are particularly excellent on the trail, because they have been shown to reduce joint and muscle inflammation.

Powdered Whole Milk

You can find powdered whole milk in the Hispanic section in most grocery stores, usually the Nestle Nido brand. Whole milk has 50% more calories (151 per ounce) than powdered skim milk and is usually a little bit cheaper per calorie.

Another reason many people, including myself, prefer whole milk is that it's creamier and tastes better in recipes, but both are a great way to add calories and protein to coffee, hot cocoa, oatmeal, and many other meals.

Cocoa drink mixes

Ovaltine with powdered milk will mix well hot or cold, which is why I stopped taking hot cocoa mix on the trail. It also tastes better to me than hot cocoa mix and is fortified with vitamins and minerals. It can also be added to oatmeal, coffee, or used in other trail recipes.

Instant Coffee or Cider

Definitely not a necessity, but when it's cold I like to have hot beverages in my pack. It can do a lot for morale at the end of a long cold day.

For more protein and calories, mix instant coffee with cocoa and powdered milk to make a trail mocha. Add a little sugar to that, drink it cold, and it tastes similar to a Frappachino from Starbucks.

Cereal

Breakfast cereals with powdered whole milk are like dehydrated foods that don’t require a stove, which is great when going stoveless or when you're unable or unwilling to cook. They are usually fortified with vitamins and minerals that hikers may become deficient in without taking a multi-vitamin.

The major drawback to cereals on the trail is they take up a lot of space in your pack. Many cereals also have a high glycemic index, so look for ones that are high in fiber and protein, such as Kashi Go Lean Cereal or shredded wheat. Dried or freshly picked fruit is a great addition.

Some cereals are also great in trail mixes and oatmeal. Cinnamon Toast Crunch, although not a healthy option, makes nearly all trail mixes better. Actually, it makes life better in general. Cereal is my comfort food.

Candy Bars

Candy bars are a cheap and convenient snack to carry and I'm always in the mood for them. Energy bars are generally higher in protein and lower in saturated fat, but they are 2-4 times more expensive and not as calorie dense. And I personally don't like the taste of most energy bars. Anyway, there are much cheaper ways to get that protein you need.

I'm a big fan of Snickers bars, but possibly the best candy bar for backpacking is Payday. It's about the same cost per calorie and has about the same calories per ounce as Snickers (134 calories per ounce), but Paydays have nearly 60% more protein and half as much saturated fat. They also don't melt on a hot day.

Peanut Butter M&Ms are also popular on the trail for their high calorie content (150 cals/oz.). They are lower in protein than Payday, however, and nearly three times as high in saturated fat. They are great in trail mixes though.

Foil pouch of Chicken, Tuna, and Salmon

Salmon and Tuna costs about $21.00 per 1000 calories. What salmon and tuna do provide, however, is protein and omega-3 fatty acids.

Tuna is a decent protein source (7g/oz), but foil pouches of chicken have just as much at half the price ($10.20 per 1000 calories).

All of these only have about 30 calories per ounce, so I rarely buy more than one or two pouches on a resupply. Of course, if you have the time and it's legal in your area, fishing makes the weight and cost of fish irrelevant.

Dehydrated and pre-cooked meats

Beef Jerky is more calorie and protein dense than tuna or chicken, with about 81 calories and 14 grams of protein per ounce. The price is comparable too, at $12.48 per 1000 calories or more.

Pepperoni is one of my favorite trail-suitable meat sources, due to its higher calorie density (132 calories/oz.) and its versatility. It's good on crackers, tortillas, trail pizzas, or eaten plain. It's also the cheapest meat suitable for the trail, if you buy a pound unsliced it can be as low as $2.63 per 1000 calories if you order it from Walmart.com. (I'll be testing out using Walmart.com for a few mail drops on the PCT, I'll let you know how that works out in a future post.) Grocery store pepperoni runs more like $4.60 per 1,000 calories, so still the cheapest meat on my list.

Another great meat option on the trail is pre-cooked bacon or bacon bits. They're great in instant mashed potatoes, salads, sandwiches, wraps, mac and cheese, and other pasta dishes. The "Fully-cooked" bacon has 126 calories per ounce and "real" bacon bits have 101, but bacon bits are half the price per ounce, at about $7.30 per 1000 calories.

If you like the taste, foil packs of Spam have 101 calories/oz., 12 g of protein/oz., and cost about $7.73 per 1,000 calories.

Lentils and other beans

Lentils are not lightweight calories, at only 33 calories per ounce, but they make my list for a lot of reasons. They are the cheapest source of calories, protein, and fiber (as low as 26¢ per 1,000 calories).

They are 1/5th the cost per gram of protein of the next cheapest protein source on my list, whey protein powder. They are not a complete protein, however, but if eaten with whole grains you can create a more complete protein dish.

Other than being one of the best sources of fiber on this list, lentils are also full of many things thru-hikers may lack in their normal diet, such as, iron, folate, vitamin B1, and several essential amino acids.

Cook time can be reduced by soaking them in a zip-loc bag of water a few hours before cooking, but I haven't found this to be necessary unless I'm trying to conserve fuel. I tend to eat them al dente to reduce cook time as well.

Whey Protein

It may seem expensive, and it is per calorie, but it's one of the cheapest, most versatile, and most convenient protein sources you can buy. It has over 24 grams of protein per ounce. Nothing else on my list even comes close. It's great in protein shakes, oatmeal, cereal, or hot cocoa.

Fruits and Vegetables

A lot of produce, although heavy calories, will pack out well: potatoes, sweet potatoes, broccoli, onions, cucumbers, squash, garlic, apples, avocados, hot peppers, carrots, and celery, for example. Also, consider picking up a bag of complete ready-made salad for your first night's dinner after a resupply. Keep produce in the center of your pack where it is coolest.

Pastries

Little Debbie snacks, honey buns, pop-tarts, and donuts may not be the healthiest food choices, but they can be cheap (pop-tarts as low as 88¢ per 1000 calories). They also require no time to prepare and are an excellent comfort food. I've said it before, but don't underestimate the power of comfort foods to improve morale on a long-distance hike.

And I'll repeat myself again, pair high GI foods like these with foods that are high in unsaturated fat, dietary fiber, and protein to blunt the blood-sugar spike. If you're going to eat them, have them with breakfast or during a mid-day snack break for their immediate source of energy, but not before bed or during periods of inactivity so you can avoid the subsequent drop in blood sugar.

Spices and sauce packets

Soy Sauce, hot sauce, mustard, honey, sugar, salt, pepper, and other restaurant condiment packets are a great way to improve recipes without carrying large quantities. I pick up a few when I'm eating in restaurants in town. You can also purchase single use sized portions of spices in many grocery stores.

Drink Mixes/Electrolyte replacement

Drink mixes with electrolytes are vital when getting this much physical activity, especially on a hot summer day climbing up mountains. Drink mixes will also make creek or lake water taste better, which helps ensure you'll drink enough. Electrolyte replacement is important enough to consider it part of your first aid kit.

Once again, thanks to Tavis Piattoly for helping me get some of my facts straight in this article. In an upcoming post, I'll use this list in a sample daily meal plan including recipes from the authors of the best-selling backpacking cookbook, "Lip Smackin' Backpacking." Please send me an email with your own recipes, comments, or suggestions, or leave them in the comments below.

Thanks for reading

-RG

- - - = = = - - -

Tavis Piattoly, MS, RD, LDN is the Sports Dietitian and Nutrition Consultant for the New Orleans Saints, New Orleans Hornets, and the Tulane University Athletic Department where he coordinates nutritional assessments, provides nutrition education, and develops individual meal plans for athletes to improve their health, performance, and recovery. In addition, he consults for numerous high schools athletic programs throughout the state of Louisiana. Futhermore, Tavis worked closely with Roy Jones Jr. and Bernard Hopkins to help them retain their boxing titles and has been working with Lance Berkman since 2011.

He is also the co-founder and Director of Sports Nutrition education for My Sports Dietitian (www.mysportsd.com), an online sports nutrition education company to help High School and College Athletes improve their eating habits to enhance performance, recovery, and health through the guidance of a Licensed Sports Dietitian.

Tavis obtained a Master’s of Science Degree in Exercise Physiology from Louisiana State University and a Bachelors of Science Degree in Nutrition and Dietetics from Louisiana State University. He is a registered and licensed Dietitian/Nutritionist. In addition, he serves on the Louisiana High School Athletic Association Sports Medicine Advisory Board.

Grocery Shopping with a Thru-Hiker, Part 1

Ryan Grayson January 6, 2014

(Photo: The wonderfully versatile peanut butter)

When non-backpacking folk ask what I eat on a long trail, many assume I carry a couple months of food on my back or that I fish, hunt, set traps, and forage for edible plants and berries. I would love to maintain that false image of me in their heads, but I've never been a good liar. A month of food would weigh nearly a hundred pounds, hunting and gathering is often prohibited, and there isn't enough time when you need to hike 20 miles a day. The truth is, other than the occasional wild berry bush, my food is foraged from grocery stores and gas stations along the way.

This series on food is about long distance hiking, with the aspiring first-time thru-hiker in mind, but it will still be relevant for any multi-day hike. The main difference is that with long distance hiking, things like budgets, resupplying along the way, limited availability of items in towns, maintaining body weight, and good nutrition are more important factors to consider. On a week-long trip, I don't worry about saving a few dollars or maintaining body weight. Nor do I think as much about proper nutrition, joint inflammation, or getting burnt out on certain foods.

Part two will be a sample long-distance hiker shopping list, but before making a list, here are a few things to consider:

How many calories do you need?

There are too many variables to know the exact number of calories you’ll need on a given day, such as body weight, gender, age, metabolism, pack weight, elevation gain, temperature, and hiking speed. You can, however, get an estimate of what you'll need then work from there.

“To get a rough estimate,” says Tavis Piattoly, MS, RD, LDN, Sports Dietitian and Nutrition Consultant for the New Orleans Saints. “First, determine your estimated basal metabolic rate (or BMR, the rate at which the body uses energy while at rest). For men the formula for your BMR equals:

88.362 + (6.077 x weight in lbs.) + (12.189 x height in inches) - (5.677 x age in years)

For women, BMR equals:

447.593 + (4.194 x weight in lbs.) + (7.869 x height in inches) - (4.330 x age in years)

That's approximately what you'll burn doing nothing but keeping your vital functions going, such as breathing and keeping warm. Next, add the following number of calories for every hour you are backpacking in a given day:

	Body Weight
Pack Weight	100 lbs.	115 lbs.	130 lbs.	155 lbs.	180 lbs.	205 lbs.
9 lbs.	318	365	413	493	572	651
10 to 20 lbs.	341	392	443	528	613	698
21 to 42 lbs.	363	418	472	563	654	745
Over 42 lbs.	408	470	531	633	735	838

I’m 6 foot, 180 lbs., 35 years old, so my BMR equals 1,861 calories. After a strenuous 10-hour hike, with maybe 2 hours of breaks, my average daily calorie needs would be about 7,000. The calories in the chart above are for strenuous uphill hiking, so the numbers may seem higher than what you normally eat, but this isn't an exact science, rather it’s a guide to get you started. You’ll need to make adjustments as you go. Most of us have plenty of fat stores to get us by until we figure it out, but you will lose about one pound for every 3,500 calorie deficit in your diet. That adds up fast on a long distance hike, so it's important to have a general idea of the calories your body needs.

“In the beginning of your thru-hike," says Tavis "Weigh yourself every 3-7 days, if possible (early morning after going to the restroom). Measure how hungry you are every 2, 3, or 4 hours. If you’re getting hungry in 60-90 minutes after eating a meal, you either didn't eat enough or it caused a spike and crash in your blood sugar, so you would need a more stable carbohydrate: quinoa, beans, whole grain cereals, like Kashi or Shredded Wheat, or whole grain bread - anything rich in fiber.”

Features of the Best Backpacking Foods

The best backpacking foods are:

Calorie dense

Calorie density has less to do with dehydrated food and more to do with fat content. Fat has just over 250 calories per ounce, 225% more than protein and carbohydrates. For comparison, a bag of mixed nuts has about 185 calories per ounce, a dehydrated pasta meal has about 110 per ounce. Dried fruit has about 85. Foil packages of tuna, salmon, and chicken and fresh produce have about 30 calories per ounce.

With a 6,000-calorie diet, if you ate a very low-fat trail diet of fish and fresh produce, you’d need to carry 90 pounds for a week on the trail. If you choose high-fat calorie-dense foods, you can get that down to about 16 - 19 lbs. Although I've never met a backpacker attempt the former, you can see how food selection can make a huge difference in your pack weight.

Easy to prepare with minimal cooking supplies

That way there's no need to carry more than a stove, cook pot, fuel, and spoon. I've gone on many backpacking trips without cooking supplies, but on a long distance hike, the ability to cook will increase your food options and make it easier to have a more healthful varied diet.

Campfires can save weight by eliminating the need to carry a stove and fuel, but they can't always be relied on due to rain or fire bans. If you're planning for campfires, be sure you have plenty of foods that do not require cooking for those rainy days.
Highly Nutritious

With the food limitations of long-distance hiking, namely the lack of refrigeration, access to fresh produce, and the need for calorie dense/high-fat foods, it’s very easy to become deficient in a variety of vitamins and minerals over time. Additionally, it's very important to reduce saturated fat and sugar intake. It's tempting to pack a lot of cheap, high-saturated fat and high-calorie junk foods, but too much can lead to increased inflammation and sluggishness. Constant soreness and lack of energy have sent a lot of would-be thru-hikers home before finishing their goal.
Non-perishable

Lack of refrigeration makes it more difficult to eat a healthy varied diet on the trail, and the need for non-perishable foods is obvious. Some perishable foods, however, can last a few hours or days without refrigeration. Hard cheeses like Parmesan and Romano will last for days if kept sealed well. Individually wrapped cheeses, like string cheese, also pack well.

A lot of produce, although heavy calories, will pack out well: potatoes, sweet potatoes, onions, cucumbers, squashes, garlic, apples, avocados, hot peppers, and carrots, for example. Also, pick up a bag of complete ready-made salad for your first night's dinner after a resupply.

Bacon, which makes all things better, is available pre-cooked at most grocery stores. Farm-fresh eggs, which have not been previously refrigerated, can keep for several days at or below 68°F. (Once refrigerated in a grocery store, however, eggs should stay refrigerated due to the “sweating” on the shell that happens from the sudden change in temperature. This can lead to bacterial growth.)

And don't forget the world is your refrigerator when it’s below 40° F. When it’s cold enough outside, your food options open up considerable, like milk, eggs, meats, cheeses, and butter. As with most perishable foods, keep them stored in the center of your pack to keep them a little cooler and avoid body heat and seal them well after opening.
Appetizing

It may seem obvious, but on a long distance hike you’ll probably get tired of even your favorite foods eventually. This is the main reason I buy my food along the way and avoid preparing mail drops before a trip and shipping them to myself along the trail. What sounds good before a trip, may make you dread dinner at the end of your day months later. You want to crave the foods you carry. It will help morale and ensure you’re going to eat enough calories to maintain body weight.
Inexpensive

Believe it or not, people who hike for several months out of the year (rather than working) are usually on a tight budget. Some of the cheapest calories on my list are: lentils, ramen noodles, whole-wheat pasta, oatmeal, Pop Tarts, peanut butter, and olive oil. All are less than $1 per 1,000 calories and lentils are as cheap as 26¢ per 1,000 calories. For a comparison, Mountain House or other brands of pre-packaged meals, run over $12 per 1,000 calories. Beef jerky costs about the same. Foil packets of tuna and salmon, about $20 per 1,000 calories.

Hiking with a group can save you a lot of money by allowing you to buy in bulk and separate the food into individual zip-top bags. If you prefer to hike alone, try to find other hikers heading to town around the same time as you. Ask if they want to share the cost of bulk foods and slow down or increase your hiking speed to ensure you get to town the same time as them.

If you're not with a group, buying in bulk can still save you money without carrying more food weight, if you carry versatile ingredients that can be prepared in multiple ways.
Versatile

Buy ingredients that can be prepared in multiple ways and with varying cook times, like pasta, oatmeal, crackers, cheese, and peanut butter. Have some meals that don't need to be cooked at all and save them for nights when you don’t have the time or simply aren't in the mood to cook. This is especially important when you run out of fuel or fire bans or rain prevent you from building a campfire.

An example of putting this information to use

I'll have more details in the next post, but as an example, whole-wheat pasta, oatmeal, peanuts, peanut butter, and olive oil fit in all of the above categories. For example, combine two servings each of cooked whole-wheat pasta, crunchy peanut butter, and olive oil, and you have one of my favorite backpacking meals, Peanut Butter Noodles. (Add salt or a packet of soy sauce to taste.) It has 1040 calories (145 per pre-cooked ounce), 96 grams of carbohydrates, 64 g of fat, 30 grams of protein, 14 grams of fiber, and costs just $0.86. That’s not much more per calorie, than even ramen noodles and much healthier too. In other words, with a little creativity, you can eat for a whole day for the cost of one pre-packaged freeze-dried meal.

These ingredients are also versatile and can be used in a number of ways. Swap out the peanut butter for 1/4 cup of Parmesan cheese and instead use the peanut butter in your morning oatmeal. In your oatmeal, mix a couple tablespoons of whey protein, cocoa drink mix (such as Ovaltine), or powdered whole milk to add additional vitamins, nutrients, calories, protein, and fat. You could also save the peanut butter to spread on whole-wheat tortillas for lunch and instead add nuts and/or dried fruit to your oatmeal. The Ovaltine and powdered milk can also be used for cold chocolate milk or hot cocoa, or use them to turn your instant coffee into a mocha.

That is all for now. I will post more food ideas in part two. Thanks for reading!

-RG

Related Articles:
Nutrition for Thru-hikers: An Interview with Sports Dietitian, Tavis Piattoly
Cooking Supplies and How to Make an Alcohol Stove

- - - = = = - - -

Nutrition for Thru-hikers, Part 3: An Interview with Tavis Piattoly

Ryan Grayson August 21, 2013

(Photo: Snack Break on the Appalachian Trail)

Click here to read part 1 of this interview

In part two of my interview with New Orleans Saints Sports Dietitian, Tavis Piattoly, we talked about the best backpacking foods, but on a long-distance hike, I’d also like to know which are the best town foods. Life on the trail often leads to nutritional deficiencies, but in town we have new choices available.

RG: When thinking of a typical trail diet, what vitamins and nutrients are likely to be limited and what should we try to eat more of when we are in town?

TP: This would depend on the town and what's available. Eating clean as often as possible will always be your best option. I feel fresh fruits, veggies, and lean protein would be three staples you want to eat when you get in town that you probably don't eat enough of while hiking. Although you need the calories (which fruits and veggies don't have much of), you also need the nutrients and antioxidants for immune support. You can pour Olive Oil or Cheese on your veggies for extra calories as well as having a few extra portions of carbohydrates to restore the gas tank.

Another common question in the forums and on the Facebook page have been about binge eating episodes, the common thru-hiker practice of eating small frequent meals at a daily calorie deficit, to reduce pack weight and then binge eating while in town. With town visits on a thru-hike usually happening every 3-7 days, would you discourage this practice completely or is there an acceptable amount of short-term calorie restriction?

First, I wouldn't recommend restricting calories on a trail, especially when you're burning calories at the rate you do. This could lead to fatigue sooner than later. Since you usually go into a caloric deficit within a few days, I would say you don't want to do this any longer than 3-4 days without starting to see some significant fatigue, especially if you’re not consuming enough fluids.

It will vary person to person as well as it will depend on the body fat levels of the Thru-Hiker. Someone with a higher body fat will do better utilizing his/her fat stores where the extra lean person will struggle with being in a deficit a little more as their metabolism is a little higher and they burn calories faster. This could lead to fatigue sooner than later.

A large meal due to being in a caloric deficit will be advantageous every 2-4 days as your body will want and need those calories. I would also recommend doing this at night so you can store some additional extra calories as fat. This will be burned off quickly the next day.

Inflammation is frequently a problem for me on a long trail and I’m certainly not alone. Ibuprofen is taken so routinely by some, that we call it Vitamin-I, because we pop a pill (or three) every morning without even thinking about it. Does this pose a health concern with regular daily usage? Are there foods that more safely support joint health and reduce muscle and joint inflammation? Conversely, are there foods that increase inflammation?

First, Ibuprofen. Most important is making sure you don't cause stomach bleeding with overuse. (See: Proper Use and Precautions) There are plenty of foods and spices that reduce inflammation:

Fresh Fruits and Veggies - Excellent anti-inflammatory foods (Berries, Pineapple)

Fish Oil Supplements - Nordic Naturals are the best in my opinion

Curry or Turmeric Powder/Supplements - Great anti-inflammatory agent

Spices - Like Oregano, Curry, Cinnamon, Basil, etc., are anti-inflammatory

Glutamine - Great for the immune system and muscle

Greens Powders - High in nutrients and lighter in weight

Fruit and Veggie Extract Gummies by Juice Plus - Great option if you can't carry too many fruits and veggies

Foods that promote inflammation are: High sugar foods, foods made with Omega-6 Fatty Acids (chips, cookies, pies, French fries, anything fried in oil, etc.), Foods high in saturated fat (high fat animal products, high fat cheese, etc.).

SawnieRobertson on the WhiteBlaze.net forums asks if you have any special advice for those who are hypothyroid.

Continue to eat frequently (every 2-3 hours), take your medicine if prescribed by your doctor, and eat lean protein at every meal as it can be thermogenic in nature.

Mizirlou, also from WhiteBlaze.net, mentioned he has suffered from Acute Mountain Sickness in the past, so wanted to know if you had something to say about high altitude nutrition. The Pacific Crest Trail (my next hike), for example, can vary from 1,000 feet above sea level to over 14,000. Aside from the energy expended to get up the mountain, will nutritional requirements change simply by being at a high elevation?

I thought it would be more appropriate to credit the source when answering this next question as Wayne has an excellent review on his site that can answer this better than I can. The link will provide a comprehensive answer to this question: http://www.wms.org/news/altitude.asp

As a non-expert, there are probably many questions that I don’t even know to ask. Are there any important questions I haven't asked that you'd like to talk about?

One component of nutrition that is often over-looked in all activities and sports is the significance of hydration. The first sign of fatigue is usually related to being dehydrated. We often wait until we receive cues of thirst before we drink but we should drink on a schedule, especially when going on a hike longer then 3-4 hours which is nothing compared to what the experienced hiker does. Regardless of the season (fall, winter, summer), hikers will excrete water through urine and sweat and without proper re-hydration strategies, the journey could become more difficult even for the experienced and well trained hiker.

As you get 2 hours into the hike, it's important to start replacing electrolytes to avoid an imbalance which could lead to many issues from cramping to irregular heart beats (if potassium and magnesium get too low). To avoid adding more weight to a pack, I like using the NUUN tablets as well as a product called The Right Stuff. The Right Stuff is excellent for heavy sweaters. Both are easy to add to water and drink. My rule of thumb is to consume 8-12 oz of fluid every 15 minutes or 16-24 oz every 30 minutes. Don't wait until you're thirsty as you'll already be 1% dehydrated.

And finally, one more important question from the forum at WhiteBlaze.net. Beer as a sports drink? Carb loading?

The average 12 oz beer has approximately 13 grams of carbohydrates, but I wouldn't rely on it to carb load as it will have a significant dehydrating effect on the body if consumed in excess. I'm sure this wouldn't make for an enjoyable hike the next day. Stick with Tequila shots. :)

I will definitely keep that in mind, Tavis, and one again thanks for answering all of our questions! As I said in part one of this interview, the good nutrition advice online doesn't often take into account the limitations that long-distance hikers face. I will now be better prepared at my next resupply.

Also, thanks to all of you that contributed questions. You had many I hadn't considered, so you made this a more thorough and informative interview. If you have further questions or comments, please leave them in the comments section below.

- - -

A Backpacker's Life by Ryan Grayson is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Nutrition for Thru-hikers, Part 2: An Interview with Tavis Piattoly

Ryan Grayson August 7, 2013

(Photo: Lunch at Redgap Pass, Glacier NP, Montana)

Click here to read part 1 of this interview

On a long enough hike, where you'll need to stop for supplies along the way, it can be very difficult to stick to a specific meal plan. That being said, in part two of my interview with Sports Dietitian Tavis Piattoly, I asked for specifics.

Tavis is the Sports Dietitian and Nutrition Consultant for the New Orleans Saints, New Orleans Hornets, and the Tulane University Athletic Department. He is also the co-founder and Director of Sports Nutrition education for My Sports Dietitian, as well as creator and host of the Next Level Podcast.

The difficulty in sticking to a strict meal plan is largely due to limited selection and having to carry our kitchens on our backs. Also, when it comes to food, the goal of most thru-hikers is to simply eat everything in sight in a vain attempt to avoid looking like an immunocompromised refugee in the end.

It would be difficult to convince most long distance hikers, myself included, to count every calorie and eat perfectly proportioned meals, but a perfect diet isn't necessarily my goal. Rather, it is to educate myself so I can make better food choices whether I find a fully stocked grocery store or have to resupply in a small town gas station. My ultimate goal is to improve my health, increase my energy, and maybe reduce some the aches and pains that come with long distance hiking.

So, before asking Tavis what foods we should eat, I asked what foods we should avoid.

TP: The foods you want to avoid as much as possible are very high saturated fat/fried foods as well as watching sugar intake. High saturated fat/greasy foods will promote sluggishness and foods high in sugar could create blood sugar fluctuations, especially if you consume them while taking a break in the hiking process.

There's a difference in how the body metabolizes high saturated fat rich foods (high fat beef, cheese, butter, other animal fats, etc.) versus your more mono and polyunsaturated fats, particularly those rich in Omega 3s. Nuts, Nut Butters, Olive Oil, Avocados, Fatty Fish, Fish Oil Supplements, and Flax are great sources of fat that will not make your body feel sluggish after consumption, especially when you're burning a high amount of calories during a hike.

Fried foods and high fat meats could have the opposite effect, but that doesn't mean to completely avoid them. They can be consumed at night after a long hike and used as recovery along with other balanced foods (starches and veggies). I typically don't recommend high fat meats to athletes 8-12 hours before any activity due to the very slow digestion process. I'd recommend leaner meats if you do consume them or have them available (i.e. Lean deli meats).

Regarding sugar intake, I know some people have said that the “sugar crash” is a myth. Malto from WhiteBlaze.net tested this out for himself. “On a couple of occasions,” he said. “I have tried to force a sugar crash by eating no other calories for three hours other than Kool-Aid, but I had no crash. I have not been able to see any difference between high and low glycemic index carbs during exercise." What are your thoughts on this?

During activity, your body is insulin sensitive, so you probably won't see a sugar crash as the body will utilize glucose as an energy source into the muscle and liver. The blood sugar will eventually get low but you won't have that feeling of fatigue or hunger like you would when resting and then consuming a ton of sugar.

A lower glycemic approach usually includes carbohydrate, fat, or protein-rich foods with more fiber and protein. Foods like nuts, apples, veggies, peanut butter, dairy products, meat, etc. are all low glycemic foods. You can make any meal lower glycemic by combining fat, fiber, and protein as these are the three nutrients which help blood sugar stabilize and also help you stay full.

How about salt? Many meals consumed by thru-hikers are very high in sodium. Is this much of a concern for someone getting this much exercise on a regular basis? What would a healthy amount of sodium be for a long-distance hiker?

I'd have to know sweat rates and how much fluid is lost in the process. I would think you'll need a minimum of 5,000 mg per day depending on sweat loss, considering it's about 2,000 for a 2,000 calorie diet. It may be in the upper limit of 7,000-8,000 mg per day for the very high calorie hikers. I would only be concerned with someone consuming too much sodium if they had a medical issue that requires them to be on a lower sodium diet (heart or kidney disease, high blood pressure, family history of stroke).

With our limited access to produce, should we be taking a multivitamin or other supplementation?

There could be a ton of nutrient deficiencies here since fruit and veggie intake are lower than normal considering they are low calorie foods. Using nutrient rich starches (potatoes, sweet potatoes), wheat germ, and fortified cereals could be extremely helpful. Many of the powdered protein carbohydrate bars are fortified with Vitamins but it would be a good idea to take a Multivitamin to get some additional nutrients you are not getting with food.

You could also look at using a Fruit and Veggie Powder that could assist with getting antioxidants and nutrients you would not be getting from food. It could be added to high calorie powered. Mix in and shake up with water.

Other supplements to consider to help with Immune Health are: L-Glutamine (10 grams per day), N-Acetyl Cysteine (1200 mg per day), and Fish Oil Capsules for inflammation (2000 mg or 2 g per day).

When we are out of energy between meals, what snacks are going to help get us up the next mountain?

Calorie dense snacks like Peanut Butter, Nuts, and Trail Mixes are best to spare glycogen and help you utilize some fat stores, but also mix this with dried fruits (dates, prunes, raisins).

Nutrition Bars like Clif Bars, Clif Builders, Balance Bars, Odwalla, Luna, and Lara Bars are all good options depending on what you like. You can also use candy bars with Nuts (Snickers, Pay Day, and Peanut M&M's) for extra calories when needed. Or additional options like Fig Newtons, Beef Jerky, and Peanut Butter Rice Krispie Treats. High Fiber and High Protein Dry Cereal can also be helpful (Kashi Go Lean and Special K Protein Plus are good options here).

Do you have recommendations for foods to eat at the end of the day for recovery?

Recovery should consist of a good balance of protein and carbohydrates to help the muscles recover (protein) and to refill the gas tank (carbohydrates). Whole Grain Pasta and Quinoa would be great choices that are light and would be easy to carry along. You could even try the instant bagged brown rice. Another option is oatmeal at night as this would be light to carry several bags of instant oatmeal. The best options would be the Quaker Low Sugar or Weight Control as it's high in fiber. They have several flavors that are excellent.

Protein for you at night will be Peanut Butter, Nuts, Protein Powder, Powdered Milk, Carnation Instant Breakfast, Protein Bars, Beef Jerky or Fish if caught and cooked.

My last question for part two is one from Max Patch at WhiteBlaze.net. He asks if you can give us one sample of a day's menu.

Breakfast

2 Handfuls of Nuts or Trail Mix (your choice)
1-2 cups of Kashi Go Lean Cereal (good fiber and protein)
Dried fruit (dates, prunes, or raisins) or 1 cup of oatmeal (if you have boiled water available)
Water or Water with Electrolyte tablets (i.e. NUUN)

Snack

Clif Bar, Nature's Valley Protein Bar, Peanut M&M's, Pay Day, or Snickers Bar
Handful of Nuts

Lunch

1-2 Peanut Butter and Jelly Wraps (Can use a Large LaTortilla Wrap which is high in fiber)
1-2 handfuls of Trail Mix or Almonds (I'd recommend creating your own mix of nuts, seeds, and fruit)
Water with Electrolytes to hydrate (1-2 Nuun Tablets or The Right Stuff for sodium replacement)

Snack

1-2 scoops of Protein Powder with Powdered Milk and Water or 3 ounces of Beef Jerky
Nutrition or Protein Bar (Clif, Clif Builders, Myoplex Original, etc)

Dinner

2 cups of Whole Grain Pasta (try Barilla Plus - good fiber and protein)
Can use 1 can of tomato sauce (optional if you bring canned anything)
2 tablespoons of Peanut Butter or Protein Bar
1 cup of dried fruit (good antioxidants)
Hydrate well

I'll just add that if you don't want to carry a can of tomato sauce or paste, you could also use the peanut butter to make Peanut Butter Noodles (one of my favorite backpacking meals.) To make the sauce, just mix together a serving of crunchy peanut butter, olive oil, a pinch of salt, and a little bit of the water left over from boiling the whole grain pasta. So good... but I'll talk more about meal ideas in a future post.

In the third and final part to this interview, we'll talk more about foods that prevent and cause inflammation, binge eating episodes (maintaining a calorie deficit on the trail then gorging in towns), and what we should eat while in town. I'm really hoping he says McDonald's with a side of Duncan Donuts. Keep your fingers crossed!

Thank you once again Tavis for offering your expert advice. Click here to read part three of our interview where we talk about the best town foods and binge eating episodes. If you'd like to read part one of this interview, please click here. If you have any other questions or comments, please include them in the comments section below.

- - -

A Backpacker's Life by Ryan Grayson is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Nutrition for Thru-hikers: An Interview with Sports Dietitian, Tavis Piattoly

Ryan Grayson July 24, 2013

A few months ago, I began researching for a series of articles on the subject held most dear to every thru-hiker: food. The Internet is full of sports nutrition advice, much of which is driven by fads and not entirely evidence-based, but even the good advice doesn't take into account the limitations that long-distance hikers face. We lack regular access to fresh food and refrigeration, for example, and our kitchens and pantries have to fit on our backs.

Additionally, thru-hikers can't always get to a decent grocery store to resupply and food selection is often limited, so it would be difficult to stick to a dietitian's specific meal plan. Instead, we need to educate ourselves, so we know how to make smarter decisions and adapt to whatever situation we're in. That is what I've been trying to do for the last few months and what these articles are all about.

In order to get this right, and not simply contribute to the bad advice on the Internet, it quickly became clear that I needed to consult some experts. I reached out to many professional sports dietitians, but I had no idea my search would lead me to meeting someone with a resume like Tavis Piattoly's. He is the Sports Dietitian and Nutrition Consultant for the New Orleans Saints, New Orleans Hornets, and the Tulane University Athletic Department. He is also the co-founder and Director of Sports Nutrition education for My Sports Dietitian, as well as creator and host of the Next Level Podcast.

Down the road, I'll combine my backpacking experience and Tavis's expert advice to write more posts about food and nutrition, but today I'll start it off with part one of a three-part interview where Tavis tackles some of my nutrition questions and questions from fellow backpackers on the WhiteBlaze.net forum and the Backpacker's Life Facebook page.

RG: First off, from a nutrition and optimal performance standpoint, how do you see long distance backpacking being different from shorter duration trips or other endurance sports?

TP: I find it very similar to other endurance or even ultra-endurance sports. When you're going on a 10-12 hour hike, you not only need a strong cardiovascular system, but you also need to be well fueled to get through a long day of activity. The intensity may not be as high compared to someone competing in a 1/2 or full Ironman, but the duration is very similar. I've estimated that when backpacking for 10-12 hours carrying a 30-40 backpack, your nutritional requirements could range from 6000-8000 calories for someone between 160-185 pounds.

I know many thru-hikers, myself included, do not get enough calories. The weight and muscle loss proves that. Although, weight loss seems to taper off after two or three weeks, even if daily miles increase. Do our caloric needs change on a long distance hike? Or is this simply because we require less calories as we lose weight and/or because we eventually develop a stronger appetite and start eating more?

There could be several reasons for this. One is they are not eating enough calories initially and they begin to realize it by noticing a reduction in energy and strength, therefore they increase their calorie intake. If you lose a considerable amount of weight (15-20 lbs.) during a hike, your metabolic rate will drop as well as your caloric needs, so it is possible for the hiker to begin to match their calorie needs once their weight stabilizes. The only way for me to truly know would be for the hiker to log everything he or she eats while logging their activity.

If you are hiking the same distance each day with a similar elevation then calorie needs will be similar if weight remains the same. It seems some days are more intense than others depending on elevation, but on average, calorie needs should be similar each day. At the same time, let's say you are averaging an intake of 5000 calories per day but burning 6000 calories per day, at the end of the week you will be in a 7,000 calorie deficit, which would yield a 2 lb. weight loss.

In those daily calories, do you recommend a certain ratio of fats, carbohydrates, and protein?

I can't say this sport has an ideal ratio that is a one size fits all. If I were to design a plan for a hiker, I'd probably design something along this ratio: 50-55% carbohydrate, 20% protein, 30% fat. It also will depend on the body type of the hiker. If I have a skinny or lean hiker with a good amount of body fat, he or she will probably tolerate carbohydrates better, so I wouldn't need to be too conservative here. If I had someone who had a higher body fat, I'd probably go a little lower in carbohydrates (40-45%) in order to utilize more fat stores as an energy source.

Protein is often expressed as a percentage of total calories, but I’ve read that there is a finite amount of protein our body can process. Is this true and what seems to be maximum amount? Is there harm in consuming too much protein?

There's never been a study that has truly examined how much an individual can truly metabolize. In regards to protein synthesis, the optimal dosage post exercise seems to be around 20 g but the key is making sure you get 6 grams of Essential Amino Acids (EAA's) with the key Amino Acid being Leucine. Leucine is key for signaling mTOR synthesis which is critical for muscle recovery and growth.

(Note: Good food sources of Leucine include: soy, beef, peanuts, salami, fish, wheat germ, almonds, chicken, chicken eggs, and oats.)

For a sport like hiking, I would recommend 1.6 - 2.0 g/kg of body or about .8 grams per pound. If you weight 200 lbs, you would need approximately 160 grams of protein/day. I would recommend at least 20% of your total calories be from protein, so this could be a lot higher than the g/kg previously recommended. This is to make sure you preserve muscle tissue during extended hikes. My concern would be if you're not consuming enough calories and utilizing muscle tissue for energy, the extra protein could help spare muscle loss and tap into some fat stores unless carbohydrate was prevalent throughout the day.

Jasper from the Backpacker's Life Facebook page would additionally like to know, “Would those percentages change over the course of a 5-month hike as your body's caloric demands increase?”

If the intensity or duration increases during the 5 months, then yes, as I'd probably boost carbohydrate intake a little. If calorie intake is sufficient and meeting the demands, we shouldn't have to alter much to maintain a high level of energy.

The quality of food consumed could have an impact on a backpacker's immune system (i.e. lack of fruits and veggies) which could make the backpacker more susceptible to infection, illness, etc., especially during a 5-month hike when the only recovery time is at night while you sleep.

Also related to this question, Malto from WhiteBlaze.net asks, “Will eating fats while hiking increase your total caloric contribution from fat, or will it reduce the calories that your body burns from fat, keeping it constant?”

Great question. If you're consuming a high fat diet, the body will utilize fat as an energy source and spare glycogen. If you can get to the point where you tap into your fat stores, then you will be a fat burning machine. Keep in mind we only have about 2000 calories from carbohydrate available to use during activity until we have to replace it. We have over 100,000 calories from fat available for use but we rarely tap into those stores because we're always consuming refined carbohydrates which prevents us from burning fat as fuel.

What are some good examples of high-fat calorie-dense foods that are suitable for backpacking? Nuts and seeds, peanut butter, olive oil, and some dark chocolates are some of the most calorie dense that I know of, but I wonder if there are others I haven't considered.

You mentioned those that are the most critical that remain stable under heat as well as don't spoil. Walnuts are best due to added Omega 3 benefits which can help fight inflammation. Another would be MCT Oil (Medium Chain Triglycerides). It could be added to veggies or starch. It's bland and the body burns it quite quickly after consumption.

I'd like to go into inflammation more in a bit, but to finish up this section, what about fiber? How much and why is it important to a thru-hiker?

The average recommended amount is between 35-45 g. I typically recommend trying to get 10 g for every 1000 calories consumed. The importance and benefits for a hiker would be to help regulate blood sugar and keep you full longer. The more stable your blood sugar and insulin levels are, the more energy you should have throughout the day. This would be the benefits of bringing foods like Nut Bars, Trail Mix, Quinoa (cook later), Whole Grain Pasta, etc. on a hike as a more stable carbohydrate will be better utilized as an energy source and keep you more full during a long day of activity.

Click here to read part two of our interview where we discuss sample meal plans, foods to avoid, inflammation, and much more.

- - -

A Backpacker's Life by Ryan Grayson is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.