Why should there be less air flow because you're hill climbing?
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It's not just less "air" (air pressure, to be more accurate) but also less "oxygen" which is needed for proper combustion. If there's too much fuel but enough oxygen, it won't combust properly, hence black smoke. NAs need the air pressure since they don't have a turbine to suck in the air. The higher up you go altitude wise, the less oxygen there is. As I understand it, turbo'd IDIs have less of a problem with it due to the forced air intake, instead of relying on natural air pressure.
If you go from sea level to 8k feet in the mountains in one day, it can make you sick because your body needs time to adjust to the chnge in oxygen level. Same reason they have to pressurize jets at high altitudes and provide oxygen masks if there's decompression, lack of oxygen.
IDIs can't adjust at all, so if they are tuned for, let's say 3,000-7,000 feet and you start going above that, the worse it'll get. Maybe it'll be fine at 8k and 9k but once you hit 10k, it might really suffer, like my F250 did. Below roughly 9k ft and it's perfectly fine, no excessive smoke, no noticeable loss of power, gets normal MPG, etc.
What I did on my F250 to help it was remove the foam liner on the (then new) air filter, and also remove the air intake tube. That did seem to help it a small amount power wise. It was still smoky but it seemed to be starving for "air" a bit less.