What You Need to Know About Travel to High-Altitude Destinations
Eventually, everyone who plans a trip to Machu Picchu finds out that their genetic pre-disposition to adjust to high altitude may be the biggest factor affecting the amount of suffering they may have to endure on their vacation. Everyone reacts differently to the realization that not only do they have to figure out how to book hotels, trains, tickets, buses and flights to a remote spot in the middle of the Andes Mountains, but they have to add symptoms of altitude sickness to the list of "things to know before you go."
For 10 years, I have been going to Cusco, Peru, La Paz, Bolivia, and Quito, Ecuador. Often multiple trips in one year. If fate somehow matches people with the most genetically compatible travel destinations, they decided to have some fun when it was my turn. "Let's see what happens when this 6' tall chica from the northern European gene pool visits Cusco. Over and over." My gringo DNA sucks at altitude. I didn't see it coming. Being an active traveler all my life, I sashayed right into Cusco, then crumbled into a whimpering heap of pity. I tried all the natural remedies you can think of; gingko biloba, chlorophyll, coca leaf, vitamins, and nothing worked. Until diamox (acetazolamide). I'm now my own anecdotal high altitude science experiment. Compared to when I first started visiting altitudes exceeding 8000 ft, I've "taught" my body to suck it up (literally). The limited supply of oxygen. And stop whining. When the doors of the plane hurl open, I'm ready. Give it to me Cusco! I stopped taking meds a couple of years ago, except for ibuprofen when needed. So far I do fine upon arrival in Cusco. But I try to avoid going to La Paz from sea level.
Exactly How High is Machu Picchu?
The reality is that Machu Picchu is not that high. Topping out at 8000 ft / 2438 m, is a notable, but modest elevation gain. But what really gets people's attention is the fact that the nearest airport in Cusco, Peru is a whopping 11,000 ft / 3353 m. And. And. One of the biggest factors affecting this whole travel scenario is that there is absolutely no way to acclimatize gradually. This violates all the rules we know about adjusting to altitude. Nearly 100% of the flights to Cusco, come from Lima, Peru, located on the balmy sea level coast. The flight is 1 hour and 20 minutes and in no way allows for any adjustment to high altitude. Take a deep breath as the doors of the plane lockup in Lima and when the doors fling open in Cusco, the first thing your body does is gasp for air (just kidding). Your body speeds up your rate of respiration in an effort to pump more oxygen-enriched blood throughout your body. (This reaction is also known to increase your metabolism and has been reported to result in weight loss. Thought you would like that)
What does it "feel" like to breathe thin air?
Our bodies are designed to breath involuntarily as well as voluntarily. Fortunately we don't have to remember to breath. But if we want to we can. When you step off the airplane in Cusco or La Paz, suddenly, the only thing you sense is your breath. Breathe you say to yourself. Breathe again. And again. I'm pretty sure I have noticed my body trying to breathe in and out at the same time. It doesn't work out well. The rhythm of breathing becomes unsynchronized and every so often I cough and gasp and have to consciously find the cadence for inhalations. It happens at night too. I'll wake myself up gasping. It only happens when I sleep at altitude. I've noticed that when I try to breath deeply, for instance when climbing a steep hill, I can't "feel" the air going into my lungs. My diaphram is moving, my mouth is gaping open like a whale scooping krill, and my body says, "OK, where is it?"
Thanks to the Inca who built Machu Picchu and many other amazing stone structures in nooks and crannies all over the Andes Mountains, we now have thousands and thousands of ordinary people of all ages trying to figure out how to adapt to high altitude on their vacation.
What can you expect?
- Loss of appetite
Dont' make this mistake
On my second trip to Peru, I made the neophyte mistake of starting our trip at Lake Titicaca. We flew from sea level to 12,500 ft / 3810m in 2 hours. That was a bad move. It hurt. Within 30-45 minutes of arrival I only wanted to lie down. And I was fine if I happened to die. By the time we got to the hotel in Puno, the best I could do was crawl into my bed and shut my eyes to keep people from talking to me. I just wanted to slip away in peace. One of the teens in our group had a similar, but less virulent reaction to the altitude. Age is not a factor for experiencing symptoms.
An amazing thing happened. Vidal was our guide, and he popped in with an oxygen tank and slapped the mask around my face. Within 4 minutes I was up and immediately resumed barking orders and annoying my travel companions. Not to mention I was starving, where was our dinner? The oxygen didn't return me to my 100% normal self, but it was close enough.
What can you do to prepare for high altitude and minimiz AMS (Acute Mountain Sickness)?
- if you live in high altitude place like Denver, Santa Fe or Mammoth Lakes, California you are pre-acclimatized and should be fine
- Drink extra water. Before you travel and while you're on the way. Dehydration makes your blood thick and sludgy. Thicker blood can affect the flow of oxygen throughout your body.
- Avoid alcohol and caffeine (if you drink coffee or tea daily, it's beneficial to have at least 1 cup to avoid caffeine withdrawal headache)
- Schedule easy activities at the beginning of your trip. Movement and mild activity can be beneficial for healthy people.
- Avoid stressful travel. If you don't sleep well on planes, then don't fly the redeye to Lima. Try to arrive in Cusco rested and as normal as possible.
- Ask your physician if a prescription for Diamox would help you (you have to take it before you arrive in order to get the benefits)
- Take aspirin or ibuprofen. Pretreatment may raise the threshold for headaches which can be beneficial the first day of arrival. (LINK TO NIH REPORT)
- Buy a pulse oximeter to measure your arterial blood oxygen saturation levels. It's a tiny non-invasive device you attach to your finger
- Train before you travel. I don't mean the Olympic training center. Exercise and fitness will help you adjust quickly. It will not alter your genetic predisposition to suffer from lack of oxygen. My gym has a special mask you attach to your face to restrict oxygen intake while exercising. Ask your gym to get one. You can train your diaphram and body to function with less O2.
- Supplemental oxygen. All hotels in Cusco and Puno have tanks. Some hotels in La Paz may have tanks. Although you can buy personal tanks at pharmacies for about $10-$25 USD, the quality of the oxygen delivery is not as good as the tanks the hotels have.
- Eat light the first day. Avoid street foods. Always drink bottled water.
When Should you Worry?
- if symptoms worsen after the first 12 hours
- hacking cough with pink or bloody phlegm
- Pregnancy. Good rule to understand. Whatever Mom is experiencing, so is baby. Ask your doctor or midwife if you should travel to high altitude destinations.
Should you go straight to the Sacred Valley (or lower altitude) when you arrive in Cusco?
If you have the choice to acclimatize at lower altitude, it could be the best option. It may depend on where you are. In Peru, we see many people online recommend going to the lower elevation of Sacred Valley (9000 ft) when you arrive in Cusco, we have a different approach. Hotels in the Sacred Valley are isolated and there is limited access to:
- public transportation
- pharmacies or medical services
- restaurants, museums or activities
All visitors to Machu Picchu will pass through the SV on the way. It's more efficient use of your time if you start in Cusco, then progress to the Sacred Valley on your way to Machu Picchu. We have not been able to find any evidence that supports this idea that starting in the Sacred Valley is better than starting in Cusco.
For visitors looking for a quiet escape and place to enjoy nature, then going to the Sacred Valley is an ideal place to start. We can pick you up on the way to Machu Picchu.
The good news is that within 12-24 hours most people will reach a level of comfort that will permit them to function normally with the exception of shortness of breath on stairs or climbs. That doesn't really go away on short visits. And it's another reason we organize our trips the way we do. We intentionally allow time for people to adjust to altitude on the first day or two. And with Machu Picchu being lower than Cusco, by the time you get to the citadel, you're ready to marinate yourself in the world of the Inca.
Is there such a thing as High Altitude Travel Insurance?
If you're participating in adventurous activities like hiking, skiing, rafting, zip-lining, it's possible that insurance companies may not cover risky activities, or activities above certain altitudes. What you need to know:
- is coverage limited by maximum altitude? And if so, what is it?
- does coverage include rescue or transportation to a medical facility from a high altitude activity?