*Note: This is a personal blog about travel at altitude, but does not replace advice or guidance from a medical professional.
Let’s talk about altitude
Of the roughly 7.6 billion inhabitants of our little planet, only several million live at high or very high altitude. In context, several billion live around sea level; just think of coastal China, Indonesia, Japan, Bangladesh (some of which is below sea level), western Europe, Eastern North America, Brazil & Argentina, etc…
Indeed, during most of our history as a species, populations grew most rapidly near water. Logically this had more to do with food security than elevation, and in a macro sense, humans exist in a narrow band of oxygenated atmosphere on the crust of our planet.
I can only let myself ponder the precariousness of our existence for so long, before a gentle nihilism sets in. Thus I will retreat into an existential love of mountains ;).
As a general guideline, ‘high altitude’ is defined as above 8000 ft / 2300m, ‘very high altitude’ as above 1200 ft / 3600m and ‘extreme high altitude’ as above 18000 ft / 5500m.
Setting aside the few hundred people who climb above 8000m (26000 ft) in the Himalayas each year, and the few thousand more who venture above 6000m (20000 ft), there are legitimate populations living permanently at high altitude.
Over the past 20 years, I have fallen in love with the high Andean environment and cultures. I have also guided many tours to high altitude destinations and have hiked and climbed throughout the region.
La Paz, Bolivia is the highest capital on earth and its airport – located in the sprawling Aymara city of El Alto sits at 4060m / 13300 ft above sea level.
Quito, Ecuador is the second highest capital at 2850m / 9350 ft although Lhasa, Tibet is arguably the second highest capital, perched at 3500m / 11500 ft.
Other high(er) cities are located in Mexico, Colorado (USA), Peru (Cusco, of course), Kashmir (India, Pakistan, China) and Nepal.
Historically the highest city on earth was Potosi, Bolivia – in my opinion, the most important city of the last 500 years: click here.
Currently, La Rinconada is the highest city on earth. It is a rough mining community of at least 50000 inhabitants. Here people mine under a glacier in the Andes, east of Lake Titicaca. Read about it here.
Coping with Altitude
As one climbs up in elevation, air thins and oxygen levels drop. This is what us mere mortals struggle with. There is really no telling who will react poorly to altitude, although colloquially it would seem young, fit people can be the worst hit!
One can not simply tough it out through altitude. The body needs to grow red blood cells, this takes time. Blood pressure increases with altitude.
Additionally, people who travel up and down to altitude, with no problem may suddenly fall ill for no apparent reason.
In the Andes, altitude sickness is called soroche. This translates to acute mountain sickness. In its worst form, high altitude sickness can result in pulmonary or cerebral edema (oedema) – swelling of the lungs or brain. This can be fatal and I have witnessed a rescue above 6000m / 20000 ft on a mountain.
These illnesses represent absolute worst case scenarios and tend to occur in mountaineering settings. Most people just want to visit Machu Picchu, Lake Titicaca or the salt flats.
General symptoms of mild altitude sickness include; headaches (forehead and/or base of the skull), nausea, diarrhoea, lack of appetite, dizziness, disrupted sleep and the sort of slowing of memory one may associate with fatigue or a hangover. We call it altitude brain!
Symptoms may occur upon arrival at the airport, but more often than not, I have noticed people struggling at night. For most people, symptoms pass within a few days, but it takes the body much longer to fully adjust.
Historically, people in the highland of South America chew coca leaves. Let me assure you that coca leaves are to cocaine as grapes are to wine. Cocaine is an evil drug infused with chemicals, whereas chewing the leaves tends to reduce hunger and offer a mild stimulus (milder than caffeine).
Coca tea is readily available and a good idea at breakfast. Commonly, when checking into hotels, in the Andes, one is offered coca tea and the recommendation is to simply sit and relax for a while.
The classic medicine for altitude is Acetazolamide (Diamox). It seems this drug increases breathing and thereby expels carbon dioxide more rapidly (particularly at night). It has been common to take Diamox for two days before arriving at altitude and for several days afterwards, but more and more people are keeping it as a treatment, rather than a prophylactic.
Ibuprofen is fine for headaches, but otherwise, take everything slowly. Your anaerobic strength does not change, but aerobically, oxygen deficit is where altitude hurts! Hence – walking downhill is easy, up can be really hard!
All over Cusco, soroche pills are for sale. I have never tried them, but am not convinced. Personal oxygen thermoses are also for sale. These are not a good idea. Even if the mix of oxygen is correct, all it does is put off symptoms for a few minutes and then force your body to readapt.
The only proven treatment for acute altitude sickness is to descend rapidly.
Oxygen is a tool to help this process – but this sort of illness in these places is extremely rare.
One’s body changes at altitude – and for many people the effect is positive. Weight loss is common, energy levels rise and after the funny, light-headed sensation, altitude is fun.
When approaching altitude, it is good to eat extremely lightly and drink a lot of water. Dehydration does occur more rapidly. NO ALCOHOL! Perhaps surprisingly, high energy drinks (Coke, Inca Cola, etc) with real sugar, are quickly absorbed and provide energy. Heavy, high protein meals are hard to digest. Locals eat delicious grain such as quinoa and enjoy soups.
Be careful with tap water. Water needs to be boiled much longer as the boiling point decreases with elevation. Here in Quito, water boils at 90.65C or 195.65F. I leaving it boiling for several minutes before making tea.
Highland cultures tend to prefer lunch rather than dinner, as sleeping on a full stomach at altitude is really hard! I always have a light breakfast with a ridiculous amount of fluids (juices are excellent in the Andes).
I do everything to avoid headaches. If I push myself too hard and develop a headache, it can take hours to pass. I once did a handstand at 6000m/ 20000 ft in Peru. I love the photo, but it does not reveal the subsequent pain and nausea!
One last important safety note about altitude in the sun.
Inca culture worshipped the Inti – the sun – and it is a powerful god. As the atmosphere thins, there is very little filter. Highland cultures are hat cultures – and Panama Hats are made in Ecuador!
At high altitude, temperatures at night drop quickly. In the Andes this is not terrible, but further from the ecuator this can be extreme.
Statistically, with a group of 20 on a tour to Peru or Bolivia, two people will get quite sick, but never dramatically so. Soroche is real, but to some extent in the head! Tour packages always include some sort of insurance, but local doctors immediately give antibiotics (available over the counter). These are pointless – the diarrhoea is a result elevation, not an infection.
There is a small percentage of people who cannot tolerate altitude (just like a very few cannot tolerate gluten ;). Most of us are fine.
Why I love altitude
I am certainly not alone in finding high altitude destinations beautiful and fascinating. With altitude comes mountains and plateaus. Also, very few mean bugs. No malaria, no zika, no deadly reptiles!
Bird and animal life is fantastic. Seeing glaciers in the tropics is magical. Once acclimatized, food is delicious and the people fascinating. From mountain communities in North America and Europe to much older societies in Asia and South America, highland environments are extremely interesting.
Altitude seems to have historically correlated with longevity and people who live at altitude have an organic sort of fitness.
In steep mountain environments, climatic zones change rapidly and therefore so does the flora and fauna. I find it all so amazing.
When most major populations developed in coastal regions, it is important to note that advanced societies grew organically in the central mountains of Mexico and high in the Andes. Cusco is the great Inca capital and the lush, terraced valleys are still capable of supporting millions of people.
Physically, I always feel better after several days at altitude. The stress on the body pushes me to make good choices with food, rest and activity. Up high some people get stronger, others struggle, but there is always a nice health bonus when returning to lower elevations.
Cheers to getting high!