Getting altitude sickness isn’t a smart move, believe me, I’ve tried it! It plays havoc with your itinerary and has the capacity to totally ruin your trip.
If you don’t recognise the symptoms and fail to do something about it, in extreme cases it can lead to more serious conditions such as HACE, HAPE or even death.
Back in 1995, I stood on the summit of Kilimanjaro. It was my second trip to altitude in a short space of time having climbed Tharpu Chuli (Tent Peak) in Nepal a couple of months before.
Standing on the Roof of Africa should have been a fantastic and memorable experience, and it was, but for all the wrong reasons. I felt terrible. I couldn’t enjoy the absolutely superb sunrise or take in the fantastic views unfolding below my feet. All I could think about was getting back down and not being sick. I had altitude sickness which was, in a way, self-induced.
Self-induced because I had chosen to climb the short sharp Marangu route and reached the summit in only four days.
Self-induced because I should have known better after having had a successful ascent of Tharpu Chuli.
The good news is that altitude sickness is fairly easy to avoid. Since that terrible ascent up Kilimanjaro in 1995, I’ve made plenty of successful journeys to altitude, all of which I’ve been able to enjoy. Drawing on this experience, I’m going to share my five top tips, which if followed, should positively contribute to any journey above 2500m to create a fantastic and enjoyable experience without any illness or need to cut your journey short.
Top Tip No.1 – Plan Your Itinerary Carefully.
On any trip to altitude your itinerary is more important than you might think. The main cause of altitude sickness is ascending too quickly.
This was the root cause of all my problems on Kilimanjaro back in 1995. Basically, the itinerary gained height too quickly and so I didn’t have sufficient time to acclimatise. This resulted in me developing altitude sickness. I was lucky to make it to the summit and felt terrible whilst I was there. My mistake was two-fold. Firstly, not factoring enough time for my trip and secondly, purposely choosing the cheapest option which just happened to also be the shortest itinerary.
The Wilderness Medical Society suggest the best approach to avoiding the problems of altitude related illness is to follow a gradual ascent profile. They advise ‘…above an altitude of 3000m, individuals should not increase the sleeping elevation by more than 500m per day and should include a rest day (ie, no ascent to higher sleeping elevation) every 3 to 4 days’.
Short itineraries are popular, reducing the amount of time you need to take off work and offer, in theory, the same outcome as longer itineraries as well as generally being cheaper. However, short itineraries are unlikely to follow these guidelines and will significantly reduce your chances of summit success. They also increase the likelihood that you will develop AMS and have to cut your trip short.
So, when planning any trip to altitude, make sure that the proposed itinerary follows these guidelines. A responsible tour operator should be able to provide you with the ascent profile for any of their trips which you can compare to the Wilderness Medical Society Guidance prior to booking.
Top Tip No.2 – Moderate Your Speed of Ascent.
It’s already been said that the main cause of altitude sickness is ascending too quickly. If you have followed Top Tip No1 then your itinerary has been designed to ensure you don’t go too high too fast, but this doesn’t account for the human factor.
If you are walking at the same speed as you walk around town when you are at altitude, then I can almost guarantee that you’ll be walking far too fast. You’ll quickly be out of breath and your pulse will be racing. Carry on at that speed and a headache will develop and before you know it, you’ll feel terrible.
To avoid this, all you need to do is moderate your speed or, in other words, walk slowly.
You should aim to walk at a speed which actually feels slow and allows you to keep your breathing rate in check and your pulse as close to normal as possible. If you can’t hold a conversation whilst walking, then it’s highly likely you are walking too fast. Slow it down. Relax and enjoy the scenery, take plenty of photo’s, there’s no rush. On trips up Kilimanjaro, the locals constantly remind you to go slowly by saying “pole pole” which is Swahili for “slowly slowly” and if you are in Nepal you’ll hear “bistārai bistārai”. Take the advice and slow it down!
Top Tip No.3 – Keep Hydrated.
Doing any form of physical exercise including trekking, uses water. As we exercise, our muscles generate heat, increasing our core temperature and so our body responds by sweating to help cool us down. It is said that only a small percentage of dehydration can result in a significant drop in physical performance. Dehydration can lead to a reduction in blood volume and a lowering of the maximum pumping capacity of your heart. It can also make you more susceptible to frostbite. All in all, being dehydrated is not great.
Trekking at high altitudes can and does contribute to a general state of dehydration. This can be further compounded by the acclimatisation process which is often accompanied by a loss of fluid and can be slowed down or inhibited by dehydration. All ingredients which can leave you feeling generally fatigued, leading to altitude sickness.
The good news is that dehydration can be avoided. If you have followed the first two top tips then you are well on the way to having an enjoyable trip free from any adverse effects. All you need to do now is to make sure you drink lots during the day. There’s no need to go overboard, but you should make a conscious effort to drink more than you usually would and ensure you pass urine more regularly too. Please don’t avoid drinking so as to avoid the need to go to the loo! When you pass urine, it should be clear, if it’s a dark yellow or yellow colour then you should think about taking more fluids on-board.
Top Tip No.4 – Eat Well.
Nutrition and a useful supply of energy are extremely important whilst trekking or climbing at altitude. Eating well is essential in order to supply our bodies with sufficient fuel to complete our chosen trek or climb. Lack of food will lower your blood sugar level and leave you feeling tired and without energy.
At altitude you should try and eat plenty of carbohydrates. Studies have shown that our body requires 8-10% less oxygen to metabolise carbohydrates when compared to fats and proteins and as such they are the ideal foods to eat at altitude. It is worth noting that fatty foods and highly refined technical sports bars which might be great down at sea level are difficult to digest at altitude and so should be avoided.
Avoid the temptation to skip meals or courses. Take advantage of any soup that is offered as a starter as soup is a great way to top up your hydration. Eat as much as you can bearing in mind that initially the altitude may suppress your appetite, which should return once you are fully acclimatised.
Top Tip No.5 – Warmth and Rest.
This is more important that you might think. After a day trekking or climbing at altitude it is vitally important to get good rest and to keep warm.
The best thing to do at the end of your day is to get out of your trekking clothing and change into warm dry clothing straight away. Put on your woolly hat and your duvet jacket and then sit, drink tea and chat. Avoid the temptation to rush about and do ‘stuff’, just rest. This approach will reduce the amount of oxygen you need and allow your body to focus on acclimatising.
When it comes to sleep, make sure you retire early. Sleeping at altitude can be difficult even when you are well acclimatised so help yourself by having the right kit. Invest in a good sleeping bag and make sure you are well insulated from the ground. A pillow is a must so think about taking an inflatable/packable one with you. Keep warm whilst trying to sleep, if you are cold your body will need to metabolise food to try and keep you warm and this uses up vital oxygen.
So, my five top tips for minimising the risks of altitude sickness and enjoying any trip, be it trekking or climbing, at altitude; plan your itinerary carefully, keep the pace slow whilst trekking, drink lots and stay hydrated, eat well and get plenty of rest whilst keeping warm.
What do you do that’s different? It’d be great to hear your thoughts and get your comments so please post them below.
About the author - Sam Marshall has been climbing and mountaineering for over 30 years. He has climbed on every continent and made 17 first ascents in a seldom visited remote and inhospitable part of northeast Greenland. He was a member of the Army Everest West Ridge expedition and has been on numerous Himalayan climbing trips including the technical Southeast Ridge of Makalu as well as Mera Peak, Island Peak, Kusum Kanguru, Tharpu Chuli, Singu Chuli and Hiunchuli.
 AMS stands for Acute Mountain sickness and is another term for Altitude Sickness.