Altitude Sickness

Check out this Facebook Group. They have shared files and lots of active members who work in medicine.

https://www.facebook.com/groups/AltitudeAcclimatization/?ref=share

Getting down quick is the best (only?) cure.

What do I do?

1) I live at 6,000 feet

2) If my trailhead is at 10,000 ft, I will car camp at 8,000 a night or two before the trip

3) go up gradually… each night a little higher

I avoid all drugs that attempt to compensate.

It is possible that you will never have this experience again… people who have never had it can get it unexpectedly; people who have always had it sometimes don’t… But going up slow is the best strategy… you body needs time to make more red blood cells..

Highly recommend the following book written by Peter Hackett M.D. who has done extensive work in the area of Mountain Sickness.

https://www.thriftbooks.com/w/mountain-sickness-prevention-recognition-and-treatment-american-alpine-club-climbers-guide_peter-hackett/1288219/#edition=1903796&idiq=3219178

This popular, indispensable book from the American Alpine Club Press offers guidelines for warning symptoms of high altitude sickness. Useful for trekkers, skiers, and climbers, this guide defines acute mountain sickness and divides it into three categories: mild, moderate, and severe. In layman’s terms, Dr. Hackett provides information on evaluation and treatment of peripheral edema, cerebral edema, high altitude pulmonary edema, and high altitude…

My wife and I were just talking about this, because there have been two rescues locally over the past couple of weeks of people who came here from sea level and went hiking. Both were hiking on a peak that tops out at only 6,800 ft. So if you live at sea level, you may need to give yourself a little more time to acclimate before going up to 10k+.

I have lived at 5500′ for a long time, so perhaps that’s the reason that I haven’t had actual altitude sickness in many years, although I definitely feel the oxygen debt when I’m over 12k. But I recall that the main solution was to head downwards.

It is my understanding and personal experience that hydration is one of the key factors in AMS.

I find the High Sierra very tricky in this regard, especially if pushing hard, even if you have had no issues on previous trips. You can easily have to climb in 100+ temps if entering from the East side, immediately putting you in debt. Then, once at elevation, temps drop and the air is quite dry, lulling you into a sense that you’re not losing as much water as you think you are. Generally speaking, my hydration goes up substantially when I’m up there compared to doing the exact same mileage at home.

I also get the sense that this ties back into conditioning for a trip. While it’s my understanding that conditioning alone is not a predictor for AMS, in my experience conditioning does play a huge role in staving off dehydration, mainly through efficiency as well as established hydration routines…

Not saying this is your situation because I don’t have the background details, but I do find a lot people head into the High Sierra for backpacking season and a 10,000’+ pass in full sun on day one is literally the first climb in a season they’ve done with a 30# pack on in full heat.

Just throwing out some things for consideration…

@W I S N E R ! I think you bring up good points. I usually do desert/dry climate hiking. I consider myself a strong hiker with a good cardio base.  On this trip a couple of things might have influenced my hydration levels. 1. it was incredibly windy the entire time. Daytime temps were 7os and nighttime was high 30’s. By the second day, heading up New Army Pass it was so cold and with the high winds,  it does trick you into thinking you are not thirsty or there is less need to drink.

Looking back, I probably drank 25% of the water I would have normally drank. As the sickness starts the critical decision skills start to get fuzzy which doesn’t help with the basics.

“Looking back, I probably drank 25% of the water I would have normally drank. As the sickness starts the critical decision skills start to get fuzzy which doesn’t help with the basics.”

And being dehyrdated itself can also impair cognition and good decision making.

I have always found this article pretty solid:

https://www.irunfar.com/into-thin-air-the-science-of-altitude-acclimation

I suspect there’s something going on with so-called “acclimation” and hydration. First, it seems that what people refer to as “acclimation” actually takes weeks at elevation to fully develop (see above link).

So I wonder if when people think they’re “acclimating” over the first couple days of a Sierra trip, i.e. going slow, camping, going a little higher, camping, going a little more slowly, camping, etc….I’d wager that the majority of the benefit is actually occurring through simply being well rested and well hydrated as they ease into more strenuous work while carrying a load…As opposed to pushing too hard, too fast, getting dehydrated, and triggering AMS.

There is my answer. Also as the sickness sets in drinking water became repulsive, just exacerbating it I guess.

I’m not sure if it makes a difference but I’ve always started drinking more than usual before I leave AZ and as I drive to the Sierras. I usually acclimate for a night or two before my permit (Parcher’s is my favorite place to do that) and I focus on drinking a lot of water. I’m not sure it is effective to “bank” hydration but I want to be sure I’m not starting off at a deficit.

I have gotten altitude sickness twice, both times on the JMT, both after spending time at 8000 feet or so in the effort to acclimate and then ascending and camping above 10k. I just don’t feel good above 10k, generally, although 8000-9000 was ok. The last trip I used Diamox, and that helped, but I still didn’t feel great. I couldn’t eat much, so basically ate about 1000 calories a day, which just wasn’t enough not to feel the bonk each and every day. I was well hydrated, with electrolytes, etc. The best solution I had on me besides the Diamox, were protein shakes. I wish I had brought more of those and less actual food. Drinking was easier than eating, for whatever reason.

The only side effect from the Diamox for me was tingling in my arms and hands. I’d feel it about 15-20 minutes after taking the meds, and then it would subside after a few hours. If I go above 10k again, I’ll take it again, take more liquid meals, go more slowly, and take some zeros. I also probably won’t go alone again at that elevation, as i did on my first trip. I hallucinated, had a hard time keeping calm and rational, and wasn’t sure I could actually evaluate my own condition reasonably. With friends, at least someone might notice if I was really struggling.

It sucks, but it is what it is.

@AK Granola I like the liquid food idea. My stomach was so sour even water was the last thing I wanted. I also had a real change in attitude. I have been on long punishing hikes and I love that part of it-this time it completely took all the mental fortitude out of me. I could see how if it progressed dangerous mistakes could be made-your thinking is impacted greatly.

I struggle with hunger while backpacking in general and that is definitely the case in the Sierra. I have had good results with Perpeteum while hiking.

I love (I use the word intentionally) Soylent in my daily life. I haven’t tried it backpacking but I’d be shocked if I didn’t like it in the backcountry. I like it mixed thinner than the directions call for. YMMV

I’ve started using liquid calories quite a bit as well, I find them very helpful during long efforts. I’ve recently dialed in a homemade version of Perpetuem that is working very well for me… Let me know if you’re interested, it’s far cheaper to make yourself.

I loved Hammer products. Been a huge fan of the Fizz tabs for years.

I’d like to know more about DIY Perpeteum.

This has been covered extensively here in the past (Greg G., AKA “Hiking Malto” did a ton on liquid calories, including a fast PCT thru hike)…but unfortunately, it all seems to be buried and the search tool…well…

Tom K. has also talked about this quite a bit and has some interesting strategies I’ve learned quite a bit from.

In a nutshell, Perpetuem is nothing but 8:1 (by weight) carbs to protein, predominately in the form of maltodextrin and soy. And a little flavor. That’s it. I used to use it in my ultrarunning and distance cycling days but stopped because it just got too pricey. I’ve gotten back into it as it’s just so convenient. I experienced a bit of a bonk about 5 hours into a training hike the other day…half a bottle and I was good in 15 minutes.

I’m currently using Carbo Gain maltodextrin mixed with unflavored whey protein (I avoid soy products except tofu). I think enough of both for 50+ servings was about $35. The more hardcore among us (mentioned above) have been known to purchase in 25 and 50# bags.

My current mix:

“Ouzelade”

72 grams malto

9 grams whey protein

I add Tang for flavor, but not too much, about 2-2.5 tsp.

Total batch comes out to around 3 ounces and a tad under 350 calories.

Resulting batch is put in a snack sized ziplock and added (tear off the corner, it pours easily) to a 16oz. bottle and shaken w/water. Surprisingly not as thick as you’d think at this concentration and once mixed it stays mixed. I’ve experimented with a few flavoring agents, pick your poison (or none at all), but have found Tang leaves the least bottle residue and is most palatable to me (I used to use orange/vanilla Perpetuem).

Anyhow, I’m looking at like $0.70/serving, versus A LOT more for Hammer.

I’ve also moved on to DIY electrolyte supplements as well as recovery drinks.

To be honest, I could care less about eating out there these days; I’d filter feed, graze on grass, or photosynthesize if I could. Getting a good portion of my calories through liquid (about 1000/day) helps to this end, especially as I’m getting back into racking up the miles and fueling while on the move. I’m not sure how much further I could push the liquid calories…nor how much I would want to. But it really makes things easy.

In the context of this thread, I find the liquid calories to be gold in that if you’re feeling low or your stomach/appetite is off and you still have miles to do, they’re very easy to get down.

Interesting mixture.  I have tried the Perpetuem Solids and found them tough to eat and easy to choke on. I practice low carb high fat so finding something with a smaller amount of carbs is hard-this recipe though I could tweak.

 I practice low carb high fat so finding something with a smaller amount of carbs is hard-this recipe though I could tweak.

Similar here in general,  though not when I’m doing endurance stuff over multiple hours. And in the context of backpacking, even at 1000cal/day liquid, if your other calories are lower carb, you could still come in at <40% carbs if you tried…but have all of that very rapidly available fuel when you need it (climbing passes, etc.).

I have spent 4 years attempting to dial in my endurance nutrition while on LCHF and still haven’t found the perfect combo for me. I can prevent a bonk most of the time if I keep output under 70%. Throw in altitude and steep climbs and it just gets more complex. Eating while really hammering is the last thing I want to do, never felt faster then while on an empty stomach.

Timely thread.

I start Friday where I left off on the CT a week ago, hiked from 5,000 to 8,000 plus and had no problems, starting at 8,000 this time could be.

Other times I’ve experienced headaches and fatigue on the first day or so once I get above about 7,000. This time I’ll go a little slower and stay as hydrated as possible.

Eating while really hammering is the last thing I want to do, never felt faster then while on an empty stomach.

Which (for me) is exactly where the liquid calories come in; I don’t feel like I’m eating, nor do I feel full if a consume a bottle in sips over the course of an hour or two.

That recipe looks great, Craig. Wondering what “Ouzelade” is… Could you clarify, please?

Craig – Thanks for the recipe. What does it taste like without the Tang?