7 Rules to Help keep Acute Mountain Sickness at Bay

One of the biggest challenges which make the completion of your trek uncertain is the possibility of being struck by Acute Mountain Sickness (AMS). I’ll start with a quick background on altitude sickness.

As one climbs above 8,000 feet, the atmospheric pressure starts to fall noticeably. With every breath you take, less oxygen reaches your blood.  Your body copes by breathing harder and longer. When you are climbing this case is acute. Persistent short breathing builds up carbon dioxide in the blood.

As you climb higher your body acclimatizes naturally to the decreasing oxygen levels. Your body builds up a ‘zone of tolerance’ – where it can function normally even with the decreased oxygen. This zone of tolerance moves up as your body acclimatizes to the higher altitudes.

However, when the build-up of carbon dioxide is beyond your zone of tolerance the body reacts and you fall sick. This is high altitude sickness.

It is accompanied by symptoms of feeling lightheaded, nausea and an unbearable headache. Acute Mountain Sickness can escalate quickly which can be fatal if not treated in time.

I have been trekking in the Himalayas for close to three decades across my 50 years of living. Having done the basic mountaineering course from Himalayan Mountaineering Insititute and an emergency medicine course from Red Cross, I have listed some ways in which I’ve learnt to prevent high altitude sickness.


1. The Fitness Paradox about Acute Mountain Sickness

Statistically,  it is observed that fitter trekkers are more likely to be affected by Acute Mountain Sickness. However, the bottom line is that physical fitness (cardio and muscle endurance) is critical to completing a trek while enjoying it.

There is actually a deep reasoning behind it. Fit trekkers think they can gain altitude much faster than what their body can humanly tolerate.

The general thumb rule is that you should not gain more than 1000 ft/day.

I have got a few more tips for you:

a. Gain an average of only 100 ft per hour: If on a given day, the route demands a gain of 1000 ft, the total time between the campsites should be about 10 hours including breaks along the way. Therefore it is mandatory to start early.

b. Take a 15 min break after gaining every 300 ft. The breaks should include deep breathing, hydration, as well as some high energy snacks such as dry fruits, energy bar, etc.


2. The Pee Colour Test and Acute Mountain Sickness

At higher altitudes, especially if the trek is on a cold and dry day, the body loses an enormous amount of water through perspiration which is not really visible. The cold temperatures, on the other hand, inhibit the sensation of thirst. The resultant dehydration can trigger symptoms of Acute Mountain Sickness. Therefore to prevent this, I came up with a very simple run-time test.

a. On the trek, continuously monitor the colour of your urine. If it is clear white to pale yellow, you are fine. If it starts to turn yellowish en-route, the body is getting dehydrated. Immediately start a cycle of hydration. Remember that gulping down litres of water in one go is not a good idea. Sip your water gradually and for a longer duration for it to absorb effectively.

b. The hydration cycle that works for me is having one glass of water every 15-20 minutes spread over 1.5 – 2 hours. I have found that without exception, this gets the body adequately hydrated and back to normal.


3. The Englishman Diet

The body is stressed at very high levels on multiple fronts on a high altitude trek. It is not the best of times to stress it by incorrect food choices.  You should eat a proper breakfast, lunch, evening snack and dinner — in addition to energy bars/dry fruits along the way. Read this article for more food ideas.

Food should be low in fat, preferably bland and have easily digestible carbs.

Avoid using chilli — it improves the taste but induces artificial perspiration which is dehydrating. What you can use instead are spices. Use a slight bit of turmeric, asafoetida, and fennel seeds. Our modern Englishman has been influenced by Indian Ayurveda.

 

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Trekkers cooking their own food on a trek. Picture By Milind Tambe

4. A Big NO to Alcohol and Smoking

Alcohol and smoking have the potential to induce both Acute Mountain Sickness as well as hypothermia. They are both potentially fatal on a high-altitude trek. Check out this video below to learn why we ask trekkers to refrain from such choices.


5. Mineral Balance and Acute Mountain Sickness

Trekking is a strenuous activity that goes on for multiple days. Medical reports suggest a significant change in mineral levels in the body during an extended high altitude trek, which could trigger Acute Mountain Sickness.

My tasty solution has been to consume ORS every day. I have always carried Electral powder with me and I drink 1 litre of water spruced with Electral every day.


6. The Golden Pace Rule

Every person has a natural rhythm and pace in their walk. I call this the golden pace. This is normally independent of their athletic ability. I have friends who are marathon runners but when it comes to walking have a golden pace of mere 5 km per hour. They can certainly walk faster as they are fit. However, any walking pace faster than the golden pace would tire the person out quickly. A tired body is vulnerable to altitude sickness.

Trekkers in Snow - Acute Mountain Sickness - Indiahikes
Trekkers marching their way up in snow Picture By Reyan Hazra

Therefore, I have found that trekking at the golden pace is better than competing with fellow trekkers. My wife is not an athlete. But she has done Roopkund and Kuari Pass without any issues. It is because she walks at her golden pace which is much different than my pace.

If you walk at the golden pace, there should be no breathlessness or feeling of exhaustion and only mild sweating. You need to change your pace if you feel tired or exhausted.

Climbing and trekking are supposed to be team-building sports. There are no individual prizes or victories. It is about the experience. Yet I have seen that trekkers very often get subconsciously psyched into meaningless races and timings.


7. Dry and then Warm Yourself at Campsites

Shea Goru - Hampta Pass - Indiahikes
The Shea Goru campsite at Hampta Pass. Picture by Venkatesh Allu

Immediately after reaching the campsite, it is important to change from your sweaty clothes (including undergarments) into dry clothes. Sweaty clothes in cold campsites lead to hypothermia conditions or an upset stomach due to indigestion.

Layer appropriately according to the temperature and wind conditions. This is among the first things to do and certainly before the well-deserved break.

I have observed trekkers catch a serious respiratory infection which is not good in a situation of reduced atmospheric oxygen. My general rule has been to set up the tent, change, and then do anything else. One should perform deep breathing exercises before going to sleep. It helps in boosting the oxygen saturation.


Conclusion

These are the rules I follow to keep Acute Mountain Sickness at bay. I hope you’ll find them useful for your next trek! If you think I have missed out on any point, do share in the comments below.

Rituraj Kumar

Rituraj Kumar

Dr Rituraj Kumar has a passion for trekking, especially in the Uttarakhand Himalayas. Balancing professional and family life, he has been able to sustain his passion over the past three decades. Over the years, he has studied the environment, people and culture of Uttarakhand. He has also done courses in mountaineering and led exploratory trekking expeditions.