How to Survive at Altitude

03 October 2022

Prepare yourself for a mountainous adventure!


It’s not just gnarly Everest pioneers who have to worry about Altitude sickness. Any mountain over 2,500m high, which includes many in the Alps for a start, requires special treatment and preparations.


As the body ascends beyond this point it begins to be noticeably affected by lower pressure (there’s literally less air pressing down on you). This means that there’s less useable oxygen in the air for your lungs to pull in.


If you ascend too high, too fast it can lead to nasty things like HAPE (High Altitude Pulmonary Edema) and HACE (High Altitude Cerebral Edema), which can be fatal. The good news is that the body automatically adjusts to the conditions, but this takes time. How long depends partly on preparation, and partly on how you are wired – some are faster than others.


Here’s our top tips on surviving – and having a brilliant time too!


Take a long run up

Scientists will haggle over whether there’s any direct correlation between contracting altitude sickness (Acute Mountain Sickness) and overall fitness, but the mountains are a punishing place if you’re not at your peak anyway. Prepare as best you can at home by doing plenty of long walks carrying a similar weight or more than you plan to carry on your expedition. Long runs/cycles and other low-intensity but long duration exercise will help too. For serious expeditions, it’s possible to begin acclimatizing at home using masks and tents to replicate conditions, which may well be a cheaper option that sitting in Cho Oyu basecamp for 3 weeks.



Stay wet

Hydration is important in any situation where judgement is required, but staying hydrated at altitude is essential. Because your lungs work harder to get oxygen at altitude, you also eliminate more carbon dioxide. This makes the bloodstream more alkaline, which is mopped up by the kidneys and excreted. This means you need to urinate more often than usual, so taking on as much liquid as possible is essential. Common drugs to combat altitude such as Acetazolamide (Diamox) also have this effect as they flush your system.


Bottle it

Gross as it sounds in normal life, take a pee bottle that’s very different in design/colour etc to your water bottle. All this extra liquid will mean regular trips to the loo in the night, and in low temperatures schlepping to the toilet tent/hole in the ground takes longer than needs be. She-wees and similar devices mean it’s not just chaps who can pull this off. Practice at home first of course to avoid hilarious disasters.


Food is fuel

Just as you need food and water the most, your body unaccountably decides it doesn’t fancy it. Appetite generally decreases with altitude, but your body needs the energy desperately. Eating becomes a real chore, but one you need to plough through. Food is fuel.


Booze cruise bad

Unfortunately, while there are plenty of calories in alcohol, it doesn’t help either hydration or recuperation, so is judged to be a bad scheme by the medics. It also interrupts breathing patterns, which isn’t very handy either.


Climb high, sleep low

A maxim that mountaineers have lived by for aeons, but still a sound one. Climb high by day, then retreat to recuperate at night. This spurs your body into responding to the thinner air, then allows it to recover more easily. Staying high prevents the latter bit, which isn’t what you want.



Symptoms of AMS

Spending time at high altitude you will probably experience some of these symptoms, which generally make you feel like you’ve got a bad hangover. They include headache, nausea, dizziness, tiredness, loss of appetite, upset stomach, feeling unsteady, shortness of breath, increased heart rate and difficulty sleeping.


If they persist it’s time to take action, because if left untreated can turn into severe altitude sickness, which in turn can lead to cerebral oedema or pulmonary oedema. Severe symptoms include: a persistent, irritable cough, breathlessness (even when resting), bubbling sound in the chest, coughing up pink or white frothy liquid, clumsiness and difficulty walking, irrational behaviour, double vision, convulsions, drowsiness and confusion.


Drugs vs Tech saviour

Some mountaineers use Diamox to aid acclimatization, and it can also be used to treat mild AMS. Next up is Dexamethasone (Decadron), a steroid that can completely remove the symptoms of AMS in a just a few hours, but continuing to ascend under it’s influence isn’t a good idea, as you need to wait until it’s worn off. Breathing Oxygen also relieves symptoms, and many organized treks also carry a portable altitude chamber (PAC). The latter sees you sealed in a pressurized bag, effectively ‘bringing you down’ an equivalent of 2000 metres in a matter of minutes. The downside being that they’re hard to manoeuvre down mountains, so it’ll be a bumpy ride once you’re in it.



Going down

Even a short descent of a few hundred metres can alleviate the symptoms above, and it’s the only real remedy. Don’t be ashamed to play it safe and go back to the last camp or go down entirely depending on the peak – it could save your life. Carrying on will not only be very miserable, but the symptoms will get worse until they’re potentially deadly .



Best high altitude challenge peaks:

Mt Blanc (4,810m) – Popping over to summit Mt Blanc is very tempting, especially for residents of the UK. But remember to schedule in several days or more to acclimatize – and to eat croissants and cheese.

Kilimanjaro (5,895m) – The highest freestanding mountain in the world and the highest in Africa, this Tanzanian challenge is extremely rewarding.

Mt Mera (6,461m) – The highest trekking peak in the world (with a cheeky short climbing pitch at the summit). Handily situated with rolling views of Everest this is one for the photo album.



Imagery: Yongyut Kumsri, Daniel Prudek, Galyna Andrushko, Meiqianbao, Maciej Bledowski


Enjoyed reading this? Check out this article about one man’s trek up Mt Rainier.




Men’s Moab Mid GTX

Women’s Moab Mid GTX