High altitude adaptation for a walk

[GPSGuided]

After reading National Geographic's World's Best Hikes: Epic Trailsand a rush of blood to the head on a Sunday morning, I am now all interested in that Mt Kailash base walk in Tibet. Given it's a major pilgrimage route, it's fairly well developed in terms of support, hence not totally a wilderness adventure with associated risks. But with the peak at 6638m, the base walk would still be in the 4500-5000m range. I am wondering how someone who has not gone to that kind of altitude apart in a pressurised jetliner would cope with the elevation? Given the 52km loop over 2-3 days, there's going to be some decent effort to complete it. Yet again, I'd be surprised if many of the pilgrims are as well prepared. So the question is, what do you think the challenge would be for a sea-level dweller to quickly adapt and be in shape to complete the walk? Doable?

[RonK]

A true pilgrimage means you walk to the mountain, not just around it. Going from sea level to 4500m quickly will almost certainly bring on altitude sickness, so however you approach the mountain, acclimatisation time will be required.

For an interesting insight into the journey, read (or hear) Colin Thubron's "To a Mountain in Tibet". It's probably most easily obtained from Audible.com.

Colin's style is a bit rambling but describes the trek and the culture and history of the local tribesmen and pilgrims beautifully. He also talks about his own difficulties with the altitude.

Oh, and take Diamox in your medical kit.

[Ellobuddha]

You should do it easy. The important thing is the acclimatisation stops. You really need to take it slow over 3000-3500 and a days stop there to acclimatise. 2-3 days seems pretty rushed to get to that height.

I got to 5416mtrs last year and found it was fine. (Thorung La) It was hard work (felt like you were sprinting everywhere) when walking in shin/knee deep snow. It gave me even more respect for mountaineers. From 3500 to 5416 then descend to 37100 it was 3 days (after having had acclimatisation day at 3500)

What height does the walk start from? Im assuming your not flown in too high?

Im sure theres plenty of guys on here that have been lots higher more often. Wheres Radson, Puppet etc????

[South_Aussie_Hiker]

Even if you spent all day in airliners, it wouldn't really help. Most are pressurised with a cabin altitude below 2000-3000m anyway.

How people adapt is an individual thing, depending on your physiology just as much as fitness. Some people who reside at sea level may have little or no difficulty with the 4-5000m altitudes, while others with the same level of fitness could be knocked off their feet for a few days.

Of course, maximising you cardio fitness and doing walks above sea level will help, but individuals of the same cardio fitness will tolerate altitude differently, so it's a guessing game.

All you can do is maximise your respiratory fitness, acclimatise as much as possible (even training at 1000m is helpful) and see how you go.

[Moondog55]

Of course, maximising you cardio fitness and doing walks above sea level will help, but individuals of the same cardio fitness will tolerate altitude differently, so it's a guessing game.

All you can do is maximise your respiratory fitness, acclimatise as much as possible (even training at 1000m is helpful) and see how you go.

I'd agree but suggest 1500 meters as the minimum altitude needed, which just happens to be Falls Creek and why lots of football teams and other athletes train there during the summer.
I did some HA walking in Niugini and while living in Mt Hagen acclimatised in a week or so but found that doubling my altitude on the walk the last thousand meters was very very hard indeed; I put that down to lack of fitness
https://www.google.com.au/maps/@-6.1791 ... 10!5m1!1e4
I could NOT make the last 200 meters of altitude to the actual summit point

[Turfa]

You really won't know how you will react to altitude until you experience it. Everyone is different & fitness level is no predictor of how you will fare. A others have said, building some acclimatisation time into your trip will improve your chances.

Did the hike up Mauna Kea in Hawaii last year......breakfast at sea level & at 4200m for lunch..... Exactly what you shouldn't do ! I am lucky & experience minimal effects, but my sister in-law had to stop short of the summit & then spent the whole trip down throwing up........a very unpleasant way to spend your trip

[GPSGuided]

Thanks to all the comments above. Yes, fully realising that altitude acclimatisation is a luck of the draw thing. Thinking it'd be routine for this trip to stay in Lhasa (3650m) for a few days to settle down with the usual touristy things, then supposedly there's a 3-4 days car ride to Darchen village (4575m), at the base and gateway to Mt Kailash. Effectively, it'll be close to a week of physiological adjustment on the Tibetan Plateau. If unlucky for the altitude, I'll be out of there already and trip cancelled. Assuming my body adjusts ok over that period, I wondered how well can one perform then on a 3 days hike of 52km with a peak of 5700m over Drolma-La Pass. 5700m!!! Is it realistic for us sea-level dwellers without specific "altitude training" back in Oz beforehand? Aerobically I am above average within our city dwellers but obviously not at elite sporting level.

BTW Ron, Mt Kailash is sacred to four Far Eastern religions and does not allow any climbing and no one has. The pilgrimage route is to do the defined circuit around the base of it. It just sounded fascinating on my first reading! Diamox? Absolutely! You can bet my medical kit will have way more than just Diamox.

SAH, yes, I am aware that airlines are pressurised to 6000' and are meaningless. Was just saying that I am very much a sea-level dweller.

MD55, are you still advertising for your winter camp visitors? LOL. Yes, only if I had the time to hang high at Falls Creek. Unfortunately not.

What's amazing is, if you look at the photo in NG's article, the walkers are just carrying a daypack on that track. Not exactly what I have in mind for what sounded like a real serious walk of 3 days. Then they talked about local walkers doing it all in one 15 hours swoop. No photo and rest time there.

[RonK]

BTW Ron, Mt Kailash is sacred to four Far Eastern religions and does not allow any climbing and no one has. The pilgrimage is to do the defined circuit around the base of it. It just sounded fascinating on my first reading! Diamox? Absolutely! You can bet my medical kit will have way more than just Diamox.

Yes, I'm aware that the mountain is sacred - I have Thubron's book. I wasn't suggesting climbing it, but trekking in from Simikot in Nepal (as Thubron did) to the base for acclimatisation.

People have been know to get altitude sickness at Lhasa, let alone at 4575m Darchen. Once above 3000m it's not unlikely.

The thing is, if you are fit, then it's just a matter of acclimatisation. Even so, you will definitely be slower at altitude, and it's most unwise to rush. My own experience in the Himalaya is that the young and fit tend to push themselves and are surprised when they get sick, whilst the older and plodding types just take it steadily and don't have a problem.

Ascending at around 5000m, you'll probably be taking no more than 30 steps at time between rests.

[icefest]

I would probably not just have Diamox (Acetazolamide) in the kit but be taking it in advance. Make sure to have nifedipine and some dexamethasone with you to deal with HACE/HAPE.
Diamox has a strong preventative effect, but has the side effect of decreasing your exercise tolerance.

I had to do a case study on acetazolamide last year that I'm happy to send to you if you're interested.

If you have some spare time/money before you go, get a oxygen deconcentrator (pressure swing, the same that is used for oxygen concentration) and use that to simulate attitude while sleeping. \
It takes about 1-2 months to adapt, but other than the mouthpiece at night requires little extra effort.
Don't do this if you are at a high risk of getting an ischemic stroke.

Wrong advice. Read this for details why: http://www.dtic.mil/dtic/tr/fulltext/u2/a571145.pdf

[RonK]

I would probably not just have Diamox (Acetazolamide) in the kit but be taking it in advance. Make sure to have nifedipine and some dexamethasone with you to deal with HACE/HAPE.
Diamox has a strong preventative effect, but has the side effect of decreasing your exercise tolerance.

I start taking a half tab twice a day at around 3000m, and have never experienced worse symptoms than a mild headache. My wife has been a trekking guide in Nepal for 30 years and never needs it.

Most importantly Diamox is a strong diuretic and will make you pee mightily - it's absolutely essential to drink plenty of water to remain hydrated.

[GPSGuided]

Thanks for the clarification there Ron. I won't have the time to go from Simikot and will just read others' experiences there. Icefest, would be interested in your case study on the subject (will PM you separately). I have not read about this 'oxygen deconcentrator' option. What do you think its efficacy? It reminds me of those "altitude training" tent/mask systems offered by some of the gyms around town. All a bit of a gimmick, making no realistic impact on our physiology. In any case, this is starting to shape up like a major medical project and time for a major revision on high altitude medicine. 5700m is getting a little serious for someone approaching the 1/2 century mark. Yes, classmate is now in Brazil celebrating his 50th and here I am discovering something different...

[radson]

Some great comments here and just some clarifications.

If you are 50 years old, thats actually a positive in the scheme of things. There is a school of thought outlined in Medicine for Mountaineering that with age comes a little brain atrophy which might give your brain some more room to swell. Also, more mature folk are generally more sensible and less of a rush to get to altitude.

Going direct to Lhasa is a big step, kind of like flying into La Paz. As others have suggested you may want to start taking Diamox early if there is no intermediary steps to Lhasa.

[urlhttp://www.traveldoctor.co.uk/altitude.htm][/url] has some good recommendations. IMO dont bother with any attempts to pre-acclimitise, i too believe they are generally gimicky. Also from Medicine for Mountaineering which is my bible, no acclimatisation really starts until 2,500 m asl. Unless i misread above, you can definitely experience problems once you have acclimatised above 3,000 m.

If you are going to take Dex and Nifedipine, you need to have the dosages 8 mg and 20 mg respectively ready and available for the someone else to medicate you. If required you probably cant self-medicate as especially with HACE you will probably be stubborn, obstinate, ataxic etc. My experience with Nifedipine when I had HAPE was that it was next to useless whereas Dex is a wonder drug. Diamox yes is a diuretic but so is altitude. You generally *&^%$#! heaps with or without diamox, thats how our bodies cope with altitude.

Have fun, dont stress too much. Do you research and be mindful of what could happen, expect some headaches but know thats normal.

[GPSGuided]

Thanks Radson! Yes, it was a rush of blood to the head this morning and I fully realise the potential challenges of organizing such a trip. Will read up lots and carefully consider its feasibility for my circumstance. Yes, dexamethsone is wonderful stuff for containing cerebral oedema. Used plenty in neurosurgery. My question here is, how much of an insult to the system is the transition from Lhasa (3600m) level to 4500-5500m level? I am aware that plenty of tourists can adapt to Lhasa after a direct flight, but no sense of impact of a further 2000m rise. Definitely a very specialised field.

[radson]

Can you take 10 days in Nepal to trek up to Dingboche or Machermo in the Gokyo or Khumbu valley before flying across to Lhasa. An option perhaps.

3,600 m to 4,500 m is a big jump. I think guidelines everywhere will state no more sleeping height gain of 500 per day and a second night for 1,000 m gain. The longer you spend in Lhasa the better you will be as well. We found over many years that going into the Khumbu that an additional night at Namche Bazaar (3,400 m) from 2 to 3 nights really helped prospective clients with altitude. Remember that its all about sleeping height as well. I am not fully aware of all the details of the Kailash trek but its your sleeping height thats the most important consideration. i.e its much less risky to pop up to 5,500 m during the day from say 4,500 m but could be deadly to sleep at that altitude from 4,500 m the night before.

[GPSGuided]

Thanks for the emphasis on the altitude of each night stop. Will double check on that. I note there are some Lhasa based tour operators who handle this location and will enquire of their services. Rather than coming up from Nepal, I may look into the option of coming up from Chengdu (also a 10 days trip). A few years ago I read a trip report on someone coming down from Lhasa to Chengdu by road and that was another fascinating read. Not sure if the roads are still as terrifying these days.

[walkon]

Never really paid too much thought and time considering the effects high altitude has on the body. Now in with your collective insights and extra research, I'm a lot more conversant on the topic.
I know why people take a long time to do Nepal/Himalaya region. It's not that they are loaded/received inheritance/midlife or spiritual crisis. Once your there and acclimatized, staying and doing more of it makes sense. If all else fails see 'Drugfest' sorry 'Icefest', he'll help.

Seriously GPGS go for it, I read those same articles and have listened to others who have been. The hunger to go is building and when you see a face light up and glow while recollecting their trip, it must be well worth doing. It's a few years away for me but one day one day I'll get there.

[GPSGuided]

Thanks for the encouragement Walkon. Yes, it could well be one of those once in a lifetime trip, except for those who has the life fortune to repeat it again and again, or if it becomes an addiction. Whilst browsing on GoogleEarth, I note it is now serviced by well built bitumen paved highways. How time have changed! I understand it would have been a real rough ride even just 10-15 years ago to access those areas. Anyway, will start the brew and see where it takes me.

Found the following diagram, showing the elevation profile of the 52km Kailash Kora circuit. The highest point is across the Drolma La Pass, 2000' of rise and fall within 10km.



Map of the Kailash Kora.

[wayno]

maximise your aerobic capacity, throw in intense aerobic sessions into your workouts. where you need to be exercising as hard as you can sustain for seven minutes... take a break and try and repeat a couple of times.... this stimulates a higher aerobic capacity than long endurance type training can do alone...

[GPSGuided]

maximise your aerobic capacity, throw in intense aerobic sessions into your workouts. where you need to be exercising as hard as you can sustain for seven minutes... take a break and try and repeat a couple of times.... this stimulates a higher aerobic capacity than long endurance type training can do alone...

Yes, build the base and endurance, then high intensity intervals in the lead up. But as many have said, ultimately, altitude sickness is highly unpredictable.

[wayno]

i read an article that made a vague reference to cell wall tension being an issue, low cell wall tension causes problems at altitude
i have read other articles saying too much omega 6 fat leads to saggy cell walls and saturated fat is better for cell wall integrity, mixture of medium and long chain,, coconut fat is medium chain saturated,,, animal fat long chain.... and people from those areas tend to eat loads of animal fat....

[icefest]

If all else fails see 'Drugfest' sorry 'Icefest', he'll help.

ouch

(Just Joking)

[GPSGuided]

i read an article that made a vague reference to cell wall tension being an issue, low cell wall tension causes problems at altitude
i have read other articles saying too much omega 6 fat leads to saggy cell walls and saturated fat is better for cell wall integrity, mixture of medium and long chain,, coconut fat is medium chain saturated,,, animal fat long chain.... and people from those areas tend to eat loads of animal fat....

There obviously can be cell wall permeability changes but I wouldn't use those graphical descriptions nor believe in how one can easily change the cell wall structure and function through limited dietary changes. "Saggy" is a non-specific term and only good to hoodwink lay people.

[radson]

FYI, I have stored this on my website as a reference..

http://brad-jackson.info/wp-content/uploads/2012/03/Wilderness-Medicine-Guidelines-for-Treatment-of-Acute-Altitude-Illness-2010.pdf

[wayno]

i read an article that made a vague reference to cell wall tension being an issue, low cell wall tension causes problems at altitude
i have read other articles saying too much omega 6 fat leads to saggy cell walls and saturated fat is better for cell wall integrity, mixture of medium and long chain,, coconut fat is medium chain saturated,,, animal fat long chain.... and people from those areas tend to eat loads of animal fat....

There obviously can be cell wall permeability changes but I wouldn't use those graphical descriptions nor believe in how one can easily change the cell wall structure and function through limited dietary changes. "Saggy" is a non-specific term and only good to hoodwink lay people.

"flabby" was the term actually, written by a Dr who researches fat Mary Enig, the reference was made here

http://www.westonaprice.org/health-topi ... y-on-fats/

[GPSGuided]

"flabby" was the term actually, written by a Dr who researches fat Mary Enig, the reference was made here

http://www.westonaprice.org/health-topi ... y-on-fats/

Another one of those dodgy US foundation hidden behind a nice name. Look at it's board members and who knows what the field expertise was with her PhD? Source of information is of utmost importance.

[GPSGuided]

Thanks Radson with that review article. Good reference!

[horsecat]

Can you take 10 days in Nepal to trek up to Dingboche or Machermo in the Gokyo or Khumbu valley before flying across to Lhasa. An option perhaps.

3,600 m to 4,500 m is a big jump. I think guidelines everywhere will state no more sleeping height gain of 500 per day and a second night for 1,000 m gain. The longer you spend in Lhasa the better you will be as well. We found over many years that going into the Khumbu that an additional night at Namche Bazaar (3,400 m) from 2 to 3 nights really helped prospective clients with altitude. Remember that its all about sleeping height as well. I am not fully aware of all the details of the Kailash trek but its your sleeping height thats the most important consideration. i.e its much less risky to pop up to 5,500 m during the day from say 4,500 m but could be deadly to sleep at that altitude from 4,500 m the night before.

+1. Most has been covered here but thought I'd chime in. Climb high sleep low is a good mantra whilst working your way up. For instance, ascend from say 3,000m to 3,5000m, then back down to sleep. Next day climb back to 3,500 / 3,800m and sleep at 3,500m. Then repeat as you go higher. That's is one of the reasons why big Himalayan expeditions go for over six weeks. This is still possible with high altitude roads as you will often go over a high pass then back down into a valley. I like the idea of a trek into the Khumbu / Gokyo areas as it is a nice gradual hike with lots of facilities and awesome views. Just lots of people, and with that brings illnesses (most times I've been to Namche I have got violently ill with food poisoning etc). I personally would avoid flying directly to Lhasa without going to near that height first as you don't know how your body will react which might result in a bad start to the trip.
Whilst there are so called "wonder drugs" for altitude I can't say I've ever needed them as I've always acclimatised carefully (to well over 7,500m). If you need drugs to help you go higher I would think carefully about doing so. Prevention is the best when dealing with the effects of high altitude and that is to drink, drink and drink, then drink more. It is not uncommon for me to down over twenty cups (or more) of tea a day. Pee should be gin clear as a guide. You may experience headaches and nausea when passing through the 4,000 / 5,000m height barrier and many people will panic thinking they have HAPE / HACE. Usually if I am height with say ten people maybe two will have issues and can't go higher at some stage and others may take two extra days to catch up with their acclimatisation as everybody is different. Fitness (whilst very important) doesn't seem to have a bearing on altitude sickness (I have seen British SAS troops and marathon runners severely hit with oedemas which is also probably due to them trying to go gung ho). I've also found that alcohol is bad (at altitude). Anyway, my advice would be to gradually gain height, or pre acclimatise in Nepal, drink lots and listen to your body (but don't worry about every little issue), and use a reputable guiding company. Also have a chat to your doctor. Another thing, if going into Tibet (and the Khumbu in Nepal) is to wear a protective buff to shield your throat and lungs from the extremely dry and dusty air as most people end up with a throat infection of sorts which can then lead to nastier issues. Go for it mate, it's just a shame they won't allow Kailash to be climbed

[wayno]

"flabby" was the term actually, written by a Dr who researches fat Mary Enig, the reference was made here

http://www.westonaprice.org/health-topi ... y-on-fats/

Another one of those dodgy US foundation hidden behind a nice name. Look at it's board members and who knows what the field expertise was with her PhD? Source of information is of utmost importance.

Mary Gertrude Enig, PhD is a nutritionist and early trans fat researcher known for her unconventional positions on the role fats play in diet and health.[1] She has promoted skepticism towards the widely held view in the medical community[2] that high saturated fat diets lead to heart disease, while she advocates for a diet based on whole foods and rich in certain saturated fats, such as those found in coconut oil and butter.[3]

Academic and professional history[edit]
Enig attended the University of Maryland, College Park (UMCP), receiving an MS, and later a PhD in Nutritional Sciences in 1984.[4] She was a faculty research associate at UMCP with the Lipids Research Group in the Department of Chemistry and Biochemistry from 1984 through 1991. While in graduate school and later as a research associate, Enig participated in biochemical research on lipids. She has published scientific papers on food fats and oils and is a former editor of the Journal of the American College of Nutrition.[5][6]

Enig is a Master of the American College of Nutrition.[7][8] She was a Licensed Nutritionist in Maryland from May 1988 to October 2008.[9]

Enig is the co-founder, vice president, and board-member of the Weston A. Price Foundation (WAPF), started in 1999 to promote nutrition and health advice based on the work of early 20th century dentist and researcher Weston A. Price.[10]
http://en.wikipedia.org/wiki/Mary_G._Enig

[GPSGuided]

Thanks Horsecat for the advice. My professional observation is too that everything works best when our natural body systems are allowed to do what they are designed for, although pharmacological/device interventions do have their place at times when our native system fails or needed a "push". Judicious application is the key. Will certainly apply the climb high/sleep low mantra when I get to the specific planning stage.

Looking on Youtube, it's amazing how 4x4 loads of tourists/pilgrims make the whole trip without difficulties nor much care in climatisation. Maybe Lord Shiva has been looking after them...

Thanks Wayno for the background. Still, be cautious in believing those vague terms when describing biological structures and messages from commercialised diet industry. Often very dodgy and lots of conflict of interest out there.

[horsecat]

Yeah, but sadly a lot die on their way over from Nepal during their once-in-a-lifetime pilgrimage but this is mostly due to inadequate clothing etc. Some from the altitude gain too though.

With the diet, I actually make sure when I go over there I am a little bit I'm overweight if possible, as the fat, then muscle tissue burns away very fast once around 5,000m. I have left Tassi at about 83kg and returned around 60kg more than once. The trekking is generally very, very slow and easy going but the weight just drops off regardless of what you do. I wouldn't recommend being morbidly obese though.

Also, if stopping on the way through Asia be cautious of the malaria drugs and the effect they can have on the acclimatisation process too as I have seen some issues which have been attributed to this. (there is no real problem with malaria in Kathmandu which I would say you will end up at some stage). Discuss that with your GP.

With the location of Kailash (being located in the centre of the universe and all) it may be hard to get a medivac if you are struck down with an oedema (chopper evacuations are not permitted in China - or at least the areas I have been to, and extremely expensive in Nepal) so ensure the company you go with - I assume you aren't a pilgrim - has a Gamow Bag or similar in case you need to be evacuated overland. An extremely slim chance, but hey, best to be sure.

One final note, be aware that permits into Tibet can be cancelled at the last minute depending on the political tensions etc. This happened to me a couple of years ago only twenty or so days out from an expedition to Cho Oyu which made me very, very cross.