How to get high: a guide to staying well at high altitude

Nov 30, 2011 6:02:34 AM

Gabi Mocatta
Lonely Planet Author

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High altitudes are just for the Reinhold Messners and Joe Simpsons of this world, right? Crazy feats up there where the air is thin lead ordinary lowland mortals into no good at all. You might get disorientated, hypothermic, lose a toe or two. It’ll be gruesome, right? Not necessarily.

High places -altitudes of 2500m and above – demand special respect and preparation. With proper planning and the right training, though, almost anyone can experience the exhilaration of rarefied air.

Here are some ideas to help you to get high, stay well and reach altitudes you would never have believed possible in the tallest mountain ranges of the world:

Train, train, train

It’s often not practical to prepare for altitude by spending time at altitude, but you can train your heart and lungs for altitude, even at sea level. Do at least four hour-long sessions a week of full-effort aerobic exercise: running, biking, swimming. In between - walk. If you’ll be carrying a load, practise carrying that. Find steep hills to climb wherever you can.

First, rest

If you’ll be flying or driving to altitude, first, rest. Spend two or three days doing little and drinking plenty (4-6 litres per day). Dehydration worsens altitude problems: so does drinking alcohol.

Keep eating

You may lose your appetite when first at altitude, but it’s important to keep eating. High up in the alpine cold, you burn more calories even at rest: eat plenty of high-carb, slow-burning energy foods.

Climb high, sleep low

Above 3000m, if the geography allows, don’t ascend more than 300m a day. If you do, plan to sleep no more than 300m higher than you did the previous night until you are well acclimatised. Acclimatisation takes 1-3 days for any given altitude.

Tough days, rough nights

Nights may be tough at first. Breathing rate slows when you sleep and you may wake frequently feeling out of air. Propping yourself up with your backpack to sleep half-sitting may help.

Know the danger signs

It’s normal to have some headaches when you’re first above 2500m. Rest, drink and medicate as you would at sea level. Breathlessness is normal on exertion at altitude – but above 3000m, watch for breathlessness when resting; a cough; a severe, persistent headache; nausea; loss of coordination or disorientation – all are signs of Acute Mountain Sickness (AMS). This potentially fatal condition demands rapid descent.

Have a plan

AMS symptoms often improve with a descent of 300-600m. Make sure your walking party has a plan of action for descent: and that’s not in the morning, it’s right now.

Try the folk (and high-tech) remedies

Andeans have chewed coca leaves for thousands of years – the alkaloids released relieve altitude symptoms. In the Himalayas, dried yak cheese (chhurpi) is said to alleviate some altitude woes. A red steak or two before arriving at altitude may increase iron levels and help produce blood cells to transport oxygen. Or take the pharmaceutical route: Acetazolamide (Diamox) begun before ascent helps acclimatisation.

And now you’re prepared, some choice destinations to get high? Here’s a top five of the most beautiful – and challenging – high altitude journeys:

1. Mt Kailash Kora, Tibet: The faithful (and fit) make the 52km circumambulation in one day – but most trekkers take at least three days to circuit the mountain at altitudes of between 4570 and 5790m. Be glad you aren’t prostrating at every step, like some pilgrims.

2. Kala Patthar – Cho La – Gokyo Lakes, Nepal: This classic circuit leads from fly-in Lukla to the best viewpoint over Mt Everest, Kala Patthar (5644m), then over Cho La Pass (5330m) to Gokyo Valley. Stay hydrated with dudh chia (milk tea).

3. Dolpo, Nepal: Land of the snow leopard. Trek from Shey Gompa to Phoksundo Lake, and then on remote, ancient pathways to Jomsom. Altitudes between 4000-5000m – be thankful for your yaks.

4. Cordillera Huayhuash, Peru: The 12-day 170km circuit of this most easterly range of the Andes is largely between 4000 and 5000m. Spectacular glacier shrouded peaks here soar to 6635m. Remember the coca leaves.

5. Simien Mountains, Ethiopia: A primeval range cut through by deep river gorges and rising to the highest point in Ethiopia, 4563m Ras Dejen. Approach the summit through on rural pathways between 20 peaks over 4000m.

Further reading:

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Comments

1 February 2012 11:19PM rklalbion247 Report this comment
just a note of caution to diabetics & others relying on calibrated measuring devices, altitude causes false readings of blood sugars,blood pressures etc. so you need manual methods of measurement.
2 February 2012 2:33PM merlyn1 Report this comment
Part 1. This is poor advice by Lonely Planet and I know its been long standing advice. It seems like this advice is put together by someone who has read articles on altitude sickness.
I have done a significant amount of high altitude mountaineering and trekking, watched people die from altitude sickness (some of who followed the advice above) but most importantly interviewed numerous people who have had altitude sickness. Here is my version of the same advice: 1. By all means be fit but fitness does NOT AT ALL protect you from altitude sickness. 2. Agree with drinking lots before and while at altitude. see part 2
2 February 2012 2:36PM merlyn1 Report this comment
Part 2 3. Climb high sleep low - agree. But the rest is pretty poor advice. When ascending (for adults start counting from 2500m) the advice used to be: limit your ascent to 300m per day and have a rest day every 3 days so you average 900m ascent per 4 days (ie average 225m per day). In a trekking scenario this will work "OK" for on average half a group. The remainder will have headaches or feel like crap with 2-5% getting so sick they have to descend. My advice is use a 4 day average of 175-200m per day ascent rate. This will mean at least 95% of the people will feel good and will reduce the headaches to less than 5% of the group. The comment about acclimitising to an altitude in 1-3 days is complete rubbish - my experience is that you are about 80% acclimitatised in around 10 days.
2 February 2012 2:38PM merlyn1 Report this comment
Part 3 For example on a climbing trip to the Khumbu to climb Pumori (7140m) which is next to Kala Patar - we arrived at our base camp near Gorak Shep after 12 days from Lukla (following a more conservative acclimitiastion schedule than time constrained commercial trekking groups) - on the first day it took us 2 hrs to climb Kala Patar, by day 4 this was down to 1hr and by day 10 we had it down to just under 30 minutes. 4. "Tough days Rough Nights" - following an acclimitisation rate of less than 175m average ascent per day (instead of the max recommended 225m) only an occassional person will have a rough night and if you do wake finding yourself breathless taking half a diamox will likely fix it.
2 February 2012 2:39PM merlyn1 Report this comment
Part 4 5. "Know the danger signs" - I have seen people die following the advice to descend 300-600m once they get altitude sickness. Altitude sickenss takes a while to show itself 24-72 hours. If you are unlucky and started to get sick 72 hours before, then to be safe you need to descend to at least 300m - 600m below the height you were 72 hours before. Which if you have been ascending at the max recommended rate of 300m per day (and just about to have your rest day) then you need to think about descending 1200m to 1500m.
6. Have a plan of action: Agree with these comments - I would like to add remember to reserve a set of batteries for your head torch for a night rescue/descent.
2 February 2012 2:40PM merlyn1 Report this comment
Part 5 7. Remedies - if you use drugs like Diamox to avoid acclimitising properly (and Diamox definitely works) - understand how and why it works so you can use it intelligently (BTW it increases pH of blood and so shifts your CO2 / HCO3 disassociation curve and therefore stimulates your breathing response). If there is interest I can provide some case studies of deaths where people followed all or part of the advice above.
2 February 2012 10:33PM thebigk Report this comment
@ merlyn1 : Thanks a lot for your posts. Would love to hear more from your experiences.
3 February 2012 10:46AM melbournestaycation Report this comment
@merlyn1: my thanks to for your information. I got altitude sickness in Sikkim, India, some years ago. I had thought I had done everything right, we took a train to Darjeeling, and then overland in a bus, so certainly didn't fly in to a high altitude. And I was fit. I actually didn't realise that it was altitude sickness at first. The yak tea made me feel even worse! It was only when I descended and some time passed that I felt better.
4 February 2012 2:47AM maximus83 Report this comment
- Agree on longer than 3 days to get accustomed. Just to give a more "down-to-earth" example, every time I go to Mexico City (around 2,500m), I'm not able to run more than 50% of what I normally do in Europe, at least for 15-20 days. Now, if you're on a high-intensity schedule, it probably takes you less, I just wanted to give another parameter... - AMS can strike much faster than 72 hours. I've been countless times with people (once myself as well) feeling VERY sick within an hour or two after having ascended rapidly (e.g. cablecar or helicopter). Be alert, always...
7 February 2012 8:01AM bartdgenco Report this comment
@ merlyn1: Thank you for your (very relevant) posts. I talk from experience, having suffered from AMS twice. As I intend to continue trekking at high altitudes, I would be very interested indeed in the cases studies that you refer to or in any other reference work that you are willing to share for that matter. My e-mail address: bartdgenco@hotmail.com Many thanks in advance!
7 February 2012 11:02AM kali737 Report this comment
I'd also be very interested to read your case studies.
8 February 2012 5:14AM ChrisMountainLeader Report this comment
Part 1: As specialist high altitude mountain leader who's worked for 15 yrs with groups of 4-100 people on Everest Base Camp, Kilimanjaro, Andes etc I just wanted to add my support to merlyn1's comments. There's definitely a 'missing manual' for high altitude trekking and it doesn't include many of the 'rules' that get continually reprinted today. (No offence LP - I like your work, but there is certainly much more to this subject). Just picking up on the point about "Fitness" for example; a reasonable aerobic fitness is useful for trekking, but not a factor in determining AMS/HACE/HAPE. In fact one of the many things I look for in the backgrounds of my clients is "Who is a marathon runner? Who is army?". These people tend to have very low body fat reserves and - more importantly - these personalities types are actually less likely to succeed.
8 February 2012 5:15AM ChrisMountainLeader Report this comment
Part 2: They are used to being aggressive, pushing hard, pushing through pain, internalizing and not communicating worries or weakness. These are all negative factors at altitude. Give me a relaxed women in her 50's carrying an extra 10lbs and a positive mental attitude and we'll get them anywhere. This year, working for the vg Kilimanjaro Journeys company, I led a group of 30 Doctors on the 19,000ft hill. You can imagine - they had all read the books, done their research - prepared for it all. 72 hours in and they had thrown all those papers out of the tent and were very glad for the practical advice that my team were giving them. Interestingly my Expedition Doctor wrote an article for Wilderness and Environmental Medicine Journal studying "Pulse Oximetry After 6-Minute Walk Test and Summit Success on Kilimanjaro" - basically fitness v success. Conclusion? No correlation. His (tongue in cheek) medical suggestion to me? "Measure the size of their cojones instead".
20 March 2012 2:45PM gabimocatta Report this comment
Thanks for all these comments which contribute usefully to the information in the article. This piece is merely a starting point. On a subject as extensive and serious as altitude, there's always more to add: so thanks for doing so. The comments about fitness are undoubtedly well-founded: fitness won't help you not get altitude sickness, and, as mentioned above, can make people gung-ho about travelling too fast. But being fit will likely make a mountain journey more easily achieveable - and probably more enjoyable...which has to be what it's all about. Extra rest days are also a great idea - and are very necessary to aid acclimatisation. The capacity for sufficient rest days should be built into any mountain journey, and used wisely, with consideration for the whole walking group. Thanks for adding to the debate everyone: altitude should never be taken lightly.
10 April 2012 12:57PM fengkaihot Report this comment
Last year,i took a <a href="http://windhorsetour.com/?utm_source=website&utm_medium=OBL&utm_campaign=Kevin target="_blank">Tibet Tour</a>,and when i got there,i can hardly breathe,it is a horrible experience.