All About High Altitude Sickness
While this article is linked to our Everest Base Camp trek experience, what you need to know about high altitude sickness and how to counter it can apply for other adventures too. Also, this article is not meant to be medical advice, and you should always consult a qualified health practitioner.
When we did the Everest Base Camp Trek, we arrived in Nepal 3 days earlier than the rest of our group. This gave us time to shake off any jet lag we might have had, and also the opportunity to walk around Thamel Square where we could buy gear for the trek. We felt prepared for the trek but we didn’t know enough about high altitude and how it affects your body.
On the morning of our 2nd day in Nepal, we were enjoying a most wonderful western buffet breakfast at our hotel, when a westerner sitting at the table next to us, engaged us in conversation. It is probably true that everyone in Nepal knows that anyone who is not Nepalese, is there for their imposing Himalayan Mountains. So when he asked us what we were doing there he was probably just making conversation!
When we mentioned that we were on our way to the Everest Base Camp Trek (or in short EBC), he turned his chair around and planted himself in front of us at our table. And that’s how a conversation of nearly 4 hours started… It turned out this guy was originally from Wales but used to be a travel guide for the EBC Trek for many years. On top of that, he had a military background (he used to be in the Royal Air Force) and was knowledgeable in the science of the body’s behaviour at high altitudes. His name was David Durkan, who we later found out was the author of a book called Penguins on Everest. In the book he talks about the dangers of novice climbers who think they are professional mountaineers.
As he explained to us how the body reacts to high altitude, it was fascinating and terrifying at the same time. He told us stories about some of the trips he led, and about how easily things could go wrong in the mountains.
While we thought we were well read up in the area of high altitude, this man gave us extremely valuable advice which we completely missed during our preparation. He told us about acclimatizing, techniques for ascending (definitely worth having a look at), signs and symptoms to watch out for, what to guard against and more…
The first important question David asked us was, “How long is your round trip from Lukla back to Lukla?” We confidently answered “11 days”, since this was the time dictated by our trekking package. We also knew that this was the time almost all trekking companies used for the trek from Lukla to Base Camp and back to Lukla.
David was concerned. He sat back, frowned and highlighted that he never took any group on that trek for less than 14 days. Naturally we became concerned as well. He said that when we go on the trek, we should pay attention to the number of helicopters that will pass over us on a daily basis. He explained that while some of those flights might be for food supplies on the way to Everest Base Camp or scenic flights for tourists, many of those flights are in fact rescue flights for people suffering from mountain sickness, a.k.a. high altitude sickness. He explained to us that no matter how fit you are, ascending to 5365m (Base Camp) and returning to Lukla in a total of only 11 days is simply too fast.
Kathmandu is at 1400m above sea level. When you land at Lukla, you have already been taken from 1400m to 2860m in a matter of 35 minutes. Already your body is taking strain from the sudden change in altitude, as the % oxygen at 2860m is significantly lower.
Types of Altitude Sickness
There are 3 types of altitude sickness. The first one is what is called Acute Mountain Sickness (AMS). Almost all trekkers suffer from a mild form of AMS during their trek. The symptoms include headaches, fatigue and sometimes insomnia as well as a loss of appetite. These early warnings should not be ignored, and you should know how to deal with them right away. We experienced all of these symptoms during our trek.
Later symptoms include shortness of breath as well as extreme fatigue, nausea and vomiting. This is the onset of the more severe forms of altitude sickness classified as High-Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema. Fully developed symptoms include respiratory failure, excess accumulation of fluid in the intra- or extracellular spaces of the brain, coma and even death. Towards the end of our trek we both experienced shortness of breath and extreme fatigue.
This is not medical advice and you should do your own research
Some people also refer to these conditions as Hypoxia, which is another way of referring to the condition in which the body is deprived of adequate oxygen. Hypoxia could be affecting the whole body, or a region of the body.
Without going into the science of how it all works, what is important to know is your body needs time to get used to the thinner air. While it is true that the percentage of oxygen in the air at high altitude is exactly the same as at lower altitude, the molecules in the air are further apart due to the drop in atmospheric pressure. Biologically speaking, your body needs to adjust as it physically has to adapt how it extracts the decreased amount of available oxygen from the same volume of air you inhale.
Even if you don’t feel any strain on your body, the process of changing how oxygen is absorbed happens regardless. When you don’t take time to rest, you add additional stress to your body and high altitude sickness can catch you unexpectedly. This is where fit people who don’t understand the importance of taking it slow have a potentially unknown disadvantage over those who are unfit. Unfit people generally take a lot more rest stops than fit people do.
While you need to be fit for this trek, you also need to rest like you are unfit. This will give your body more quality time to adjust as you ascend with a much better chance of avoiding high altitude sickness. This is also where you can benefit by adding more days to your trek.
After our conversation with David, we requested to start our trek a day earlier. Our contact person at the company was very helpful, and he went out of his way to arrange for us to fly to Lukla a day earlier. While it was still not 14 days, 12 days was better than 11. This gave us one extra day ahead of the rest of the group. If you read the account of our experience of the trek, you will see that this one additional day turned out to be a necessity, and meeting David was clearly divinely appointed.
Using Acetazolamide To Counter High Altitude Sickness
The one thing everybody wants to know is, should I take any medication to counter high altitude sickness? Acetazolamide is a medication often prescribed and used for the prevention of high altitude sickness. It comes under different brand names, of which the most famous one is probably Diamox. Many people claim this works for them. However, after looking at the possible side effects of acetazolamide we decided we were not going to use it, but we would take some with us just in case. Having said that, if you are going to take Diamox you should follow your doctor’s prescription.
Tip: At the time of our departure to Nepal, we couldn’t find any Diamox in our home country. However, we were able to find a different brand of Acetazolamide at a pharmacy in Thamel Square.
Using Natural Supplements To Counter High Altitude Sickness
During the preparation for our trip, we came across an article which explained that a study was done where humans on an Everest Expedition were monitored. What they found was that daily doses of vitamin C, E and Alpha Lipoic Acid reduced the effects of altitude. The article also explained that Glutathione appears to be quickly depleted at high altitude, making the body susceptible to the many forms of damage which it can usually protect itself from under normal circumstances.
Being more of a naturalist, Hank felt more comfortable with this approach. We were already familiar with a Lypo-Spheric form of Glutathione (developed by LivOn Labs), which is supposed to be more effective than other forms of this powerful antioxidant.
We also got the Lypo-Spheric form of Vitamin C, which is a product we highly recommend. The Vitamin C can serve as a counter measurement of the high altitude, but is also great to fight off any potential bacterial, viral or parasitical infections (a great added benefit on a trip to any 3rd world country).
Another important supplement that could potentially counter the effects of high altitude sickness, is L-Glutamine. Apparently there was a study where rats were fed doses of Glutamine at high altitude, and the rats were 4.5 times more resistant to hypoxia than other rats who did not receive this treatment. While we did not take L-Glutamine, it might be another useful supplement for your consideration.
Tip: Running egg yolk is a great source of the amino acid cysteine, which is a precursor to glutathione. Eggs for breakfast are readily available throughout the trek, which may also increase your glutathione levels.
Things You Can Do On The Trek To Counter High Altitude Sickness
The most effective way to counter high altitude sickness is to go lower. If you feel like you are taking too much strain, feeling nauseous, light headed or suffering headaches, the best thing you can do is to go down a few meters. Sometimes even 2 or 5 meters lower can make a difference. Once you have descended a bit, take a proper rest before you continue with your trek. Depending on the severity of the symptoms, resting at a lower altitude for 2 to 4 hours should not be discounted. In some cases it could take 3 to 4 days, but if you are careful from the start this shouldn’t have to be the case.
The Nepalese people believe in garlic soup as a great counter to high altitude sickness. If you end up suffering a headache, your porter or guide will most definitely tell you to have garlic soup. We took garlic soup a few times, and we felt it helped significantly.
Another thing that is of utmost importance is to drink lots and lots (and lots) of water. David told us we needed to drink a minimum of 4 litres of water every day. This becomes a deliberate decision, as many people tend to feel less thirsty at high altitude, just like many people tend to lose their appetite.
The reason why it is important to drink lots of water is because the rate of water vapour lost from the lungs at high altitude is much higher. If you don’t drink lots of water and you develop a headache, you might confuse Acute Mountain Sickness symptoms with dehydration. Water is also important to keep all other bodily functions working, so you don’t want to compromise your body’s ability to naturally counter the effects of high altitude by not drinking enough water.
There is a down side to drinking a lot of water, and it has to do with the fact that this amount of fluid intake demands a proportional amount of toilet breaks – which is most of the time pretty inconvenient when wearing many layers of clothing. You also end up taking more toilet breaks during the night. However, drinking enough water is more important than your comfort, so do not compromise by drinking less water.
Climb High, Sleep Low
Some people say that once you ascend above 3000m, you should not ascend more than 300m per day to sleep – whether you are hiking or driving. While it is okay to climb as high as you want for the day, the important thing is to come down to no higher than 300m than the previous night’s sleeping elevation.
This rule is pretty much impossible to apply when doing the Everest Base Camp trek in less than 14 days. It is also the reason why so many people die when climbing Kilimanjaro where you ascend even up to 1000m per day.
Take It Easy
As mentioned before, taking it easy is key to countering the effects of high altitude. The danger of going too fast without realising it is real.
For your convenience we have put together a chart that explains the Relative Oxygen Rate at Different Altitudes. What is significant about this chart is you can see how available oxygen decreases as you reach your stops on the Everest Base Camp Trek.
Whenever you plan a trip where you will ascend above 3000m, it is important to have a more relaxed itinerary. When you rush things you are more likely to run into trouble. Remember to eat regularly, drink lots of clean water and take any supplements that might help counter the negative effects of high altitude.
Be acquainted with the symptoms of high altitude sickness, and know when to go lower or when to seek medical treatment.