By Alan Safdi, M.D., FACG
There’s nothing worse than landing in your favorite mountain town only to be hit hard with altitude sickness. Going quickly from low to high altitude can cause headache, fatigue, and even nausea. Acute mountain sickness affects more than one in four people who travel above 11,600 feet (3,500 meters). While you won’t find many hotels at that elevation, most major ski resorts in the Rocky Mountains, and many in Europe, have lifts and restaurants rising that high – so you may be at risk.
At 8,000 feet – the typical base elevation for a Colorado ski resort – each breath takes in only about 75% of the oxygen you get at sea level. There’s a myth that your level of fitness determines your risk of altitude sickness, but it’s really based on genetics. Even if you’re fit, 8,000 feet may bring shortness of breath with exertion (like climbing stairs). Halfway up the mountain, at 9,500 feet, you’re working on about 70% of sea level oxygen, and at the summit (12,000 feet) the oxygen level is 60%. No wonder we feel breathless with exertion.
It’s not unusual to have trouble sleeping the first night at altitude. If you have a rough night, do a reality check in the morning. If, 6 to 12 hours after arrival, you experience headache, fatigue, some loss of appetite, nausea, vomiting, lightheadedness and insomnia, you may be suffering from acute mountain sickness. The problems usually improve in one or two days if the traveler doesn’t go higher. In fewer than 1% of cases, symptoms can grow worse and turn into high-altitude cerebral edema.
Over the course of a couple of days, most people begin to adapt to altitude by creating more red blood cells. The red blood cell, the erythrocyte, carries oxygen in the blood and since we are inhaling fewer oxygen molecules we need more oxygen-carrying capacity. The heart rate also increases, to pump more oxygenated blood to the tissues, and this is most noticeable the first several days at altitude.
How do we prevent some or all of these potential problems? When going to the mountains, think about spending a day or two at a medium altitude to acclimatize gradually. One easy preventive solution is to ascend slowly (fun fact: the CDC advises no more than 1,000 feet of elevation gain per day at altitudes above 12,000 feet). Take it easy the first couple of days. Avoid tobacco and alcohol and other depressant drugs including barbiturates, tranquilizers, and sleeping pills. These depressants further decrease the respiratory drive during sleep, resulting in a worsening of the symptoms.
Avoid alcohol beginning 48 hours prior to your trip. “Cabin altitude” – the air pressure inside a commercial airliner – is typically 7,000 to 8,000 feet. That means you’ll be exposed to high altitude conditions for a few hours even before arrival. If you board the plane with a cold, there’s a good chance the pressure change will drive the infection into your inner ears. If you’re healthy getting on the flight, you’re still vulnerable to dehydration. Drink lots of water or liquids that replace electrolytes, beginning before travel. Avoid sugary or caffeinated beverages such as soft drinks. Think about hydration this way: You don’t want your blood to thicken. When it does, blood flows more slowly through the capillaries in your brain, leading to headache and sleeplessness.
Sleeping pills may be contraindicated. You very well may notice for a couple of days increased urination, which is one response to changes in your body’s acid/base balance and helps your acclimatization process.
Make sure to have a very healthy diet including healthy carbohydrates. Your appetite may decrease at altitude but try and take in an adequate amount of healthy calories. Have healthy snacks available.
Being fit may not prevent altitude sickness, but since there is less effective oxygen, a higher fitness level when you arrive will make your trip more enjoyable. Also, never forget to start a stretching and fitness program well before your trip if possible. Trying to get fit at higher altitudes is difficult. Most of the exercises to become ski-ready can be done without any equipment, from the comfort of your home. Stability balls or Bosu balls can maximize your efforts. Remember to start well before your trip.
Here are a few of my favorite exercises to prepare my body for skiing:
1. Jumping rope. Start for one minute and build to three minutes.
2. Run sprints in your neighborhood, on a track or on a treadmill. Downhill skiing is often like sprinting with short bursts of vigorous exercise.
3. Lunges can be beneficial to build quad strength.
4. Do squats, but make sure not to overextend your knee over your ankle.
Want more beta on ski fitness? Check out these articles:
Balance exercises can be helpful. And, don’t forget your core exercises. Start stretching exercise before your ski trip and continue them during your trip. Using a foam roller or exercise band to help stretch after skiing will may help your muscles recover faster. Check out our article on pre-ski stretches here and après ski stretching here.
What are the basic treatments of acute mountain sickness? The only cure is either acclimatization or descent to a lower altitude. Some of the symptoms can be treated with pain medications for headache (like acetaminophen or low dose short term ibuprofen like agents) and Diamox (Acetazolamide). Diamox allows you to breathe faster so that you metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation. Diamox stimulates breathing, raises blood oxygen and increases urination. This is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, it is advisable to start taking it 24 hours before you go to altitude and continue for at least five days at higher altitude. The recommendation of the Himalayan Rescue Association Medical Clinic is 125 mg twice a day (morning and night and the 250 mg dose was not more effective). Possible side effects include tingling of the lips and fingertips, blurring of vision, and alteration of taste. Side effects subside when the drug is stopped. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs should not take Diamox.
You can buy or rent oxygen concentrators and using oxygen at night may help considerably. It is amazing how many changes take place in the body to allow it to operate with decreased oxygen. It’s now common to find canned “recreational” oxygen for sale in ski town shops – look for brands like Oxygen Plus and Boost (these products are not allowed on airplanes, so buy them after arrival).
We discussed here the most common form of altitude sickness which is usually mild. More severe forms and High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE) are rare and beyond the scope of this post. Make sure you discuss all recommendations and this information with your healthcare provider prior to implementing my solutions.
Dr. Alan Safdi is past chairman of the Section of Gastroenterology at Deaconess Hospital and served as co-founder and president of the Ohio Gastroenterology and Liver Institute. Dr. Safdi is board certified in internal medicine and gastroenterology, and is a Fellow of the American College of Gastroenterology. He is former chairman of the Crohn’s and Colitis Medical Advisory Board in Cincinnati and still serves as president of Consultants for Clinical Research. He was also co-founder of eMerge Health Solutions, Consultants for Clinical Research, and outpatient GI and anesthesia programs.
The information included in my posts are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in my posts does not create a physician-patient relationship.
Alan V. Safdi MD, FACG