What You Need to Know About Travel to High-Altitude Destinations
Everyone reacts differently to high altitude based on a variety of factors including their current state of fitness, their previous exposure to high altitude, how well they're hydrated before arriving in Cusco and perhaps even how your lifestyle choices affects the expression of your God-given genetic code.
For over 15 years, I have been going to Cusco, Peru, La Paz, Bolivia, and Quito, Ecuador. Often multiple trips in one year. I tried all the natural remedies you can think of to adjust to high altitude including gingko biloba, chlorophyll, coca leaf, vitamins, and nothing worked. Until diamox (acetazolamide) which is available by prescription in the US. I'm my own anecdotal high altitude science experiment. Compared to when I first started visiting altitudes exceeding 8000 ft, I've noticed that my body seems to adjust more easily with each trip, in spit of getting older. I stopped taking any meds for altitude in 2017, except for ibuprofen when needed. So far I do fine upon arrival in Cusco. But I try to avoid going to La Paz directly from sea level. I'm still ldearning about acclimatization and here's my latest info.
Can DIY Breath Training Help Travelers Adjust to High Altitude?
Since those early days, I've learned how to use my breath to train my body to adapt to high altitude. It's been exciting to discover how your respiratory fitness can help you, or hinder you, at higher altitudes. What is "air hunger?" What is your BOLT score? And would you be surprised to find out that deep breathing through your mouth might actually be detrimental to getting the most oxygen molecules into your tissues? It turns out the process of increasing oxygen absorption is 2 steps. I love my gadgets, especially my cheap little pulse oximeter device. But I have recently learned that oxygen saturation is a measure of how much oxygen is in your bloodstream, which has nothing to do with absorption into your tissues. The important thing to know about adjusting to high altitude is that you actually want the oxygen in your tissues. Saturation in the blood stream is just the beginning of the story of how oxygen is processed by the human body. It's more involved than just sucking up a couple of deep breaths. The 2nd half of the process is to decouple the O2 from the hemoglobin (red cells).in your circulatory system, and to do that you need carbon dioxide.. Oxygen just doesn't float in to the tissues. CO2 is critical baby! Carbon dioxide plays an essential role in oxygenating your muscles and tissues. I was curious about the science so here I'll share the rabbit holes I visited to learn more, including techniques to practice.
- Here's a link to youtube to view Patrick McKeown on Breathing Techniques for Running and Health.
- Here's another fascinating podcast with Ben Greenfield and Patrick about how to Maximize Oxygen Utilization Efficiency and Simulate High Altitude Training. These are free resources for anyone who is curious how they can retrain their body to breathe more efficiently before traveling to high altitude.
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 the airport in La Paz, Bolivia at 14,000 ft) 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's the air?"
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 are the symptoms of high altitude sickness?
- Loss of appetite
Dont' make this mistake when traveling to high altitude destinations
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. (remember, I'm a kidder!) 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 altitude symptoms.
An amazing thing happened. Vidal, who was our guide, 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. Now that I know about the breathing techniques, I'll be using them for sure. This is why many hotels in Cusco and Puno have oxygen tanks in their lobbies.
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
- Work on your BOLT score and retrain yourself to breath nasally.
- Learn how to use "air hunger" to your advantage as you prepare for your trip. I'm estimating you'll need at least 4 weeks to see results. But this kind of training could be useful for the rest of your life.
- 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, However, 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 the lower altitude in the Sacred Valley is low enough to make a substantial difference in adjusting to the altitude.
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 search, rescue and transportation to a medical facility from a high altitude activity?
Here's a link to Squaremouth Travel Insurance on our website. Get a free quote or call the toll free number to speak with a trained agent.