Imagine your worst hangover. Dizziness, nausea, loss of appetite, the deep desire to just lay down, wherever you are, and sleep. Now, imagine that instead of waking up in your bed after a night out, you’re three quarters of the way up a 12,000 ft. mountain, pushing yourself harder than you ever have in your life. You are experiencing the early symptoms of acute mountain sickness, (or AMS), commonly known as altitude sickness.
Altitude sickness is an illness that develops when the body doesn’t have time to adapt to the decreased air pressure and oxygen levels of high altitude—defined as any area 8,000 ft. above sea level. Symptoms include dizziness, fatigue, shortness of breath, and loss of appetite—wickedly similar to a brutal hangover.
In its most extreme cases, altitude sickness can develop into high altitude pulmonary edema (HAPE), an accumulation of fluid in the lungs, and high altitude cerebral oedema (HACE), swelling of the brain due to a lack of oxygen. Jon Krakauer provides a chilling description of Ngawang Topche, a Sherpa on the 1996 Everest expedition, experiencing HAPE in John Krakauer’s book Into Thin Air. “Ngawang was delirious, stumbling like a drunk, and coughing up pink, blood-laced froth.”
Don’t let this scare you off your planned trip to Kilimanjaro or Everest Base Camp, though. HAPE and HACE are extremely rare. They typically occur when people ignore the symptoms of altitude sickness and continue to physically exert themselves. Just be wary that if you let altitude sickness progress to this level of severity, it can prove fatal.
To ensure this doesn’t happen, follow these tips on how to handle altitude sickness.
We get it. You want to be the first one to the top of the mountain. But it’s not worth it if your group has to drag you back down. Don’t turn your ascent into a competition. By not giving your body enough time to adjust to the lack of oxygen you’re much more likely to experience altitude sickness.
According to contemporary research, age, sex and physical fitness have no bearing on a person’s likelihood to be afflicted by the illness. This means that even if you’re one of the fittest people on the planet you can still be affected, especially if you’re racing to the summit.
Before even starting your climb, it’s a good idea to take two to three days to acclimatize to higher altitude. Avoid flying directly into high altitude areas, though. Travel to the destination progressively, acclimatizing as you go.
During the climb, take it slow. Enjoy the view. If you’re hiking with porters or Sherpas, follow their lead. They know the mountain well and will know when it’s best to take a rest. If you’re climbing alone, don’t ascend more than 500 metres a day. After every 900 metres, or three or four days of climbing, take a rest day to avoid overexertion.
Remember, it’s not a race.
Stay hydrated and fed
Dehydration is a major cause of altitude sickness. In part, because high altitude has a diuretic effect on the body, causing you to pee…a lot. And with all the hiking you’ll be doing, you’re going to sweat out liquids fast. Take some hydration salts with you and toss a hydration pack in your bag that you can sip on during the hike. It’s better to carry too much water than not enough.
And just to clarify, no, beer doesn’t count as a liquid. Alcohol dehydrates you and can accelerate the altitude sickness. Save the liquor for the bar. Instead, bring water or sports drinks like Gatorade.
Altitude also tends to rob you of your appetite, slowing down your digestion. To have enough energy to hike each day, eat more than you feel is necessary. Oatmeal is a good idea in terms of meals, especially if you add some nuts and berries. And bring snacks for the climb. Munching on a chocolate bar along the way may give you the energy you need to make it to the summit.
Treat Symptoms immediately
As mentioned earlier, if not treated, altitude sickness can evolve into worse illnesses like HAPE and HACE. If you are feeling the onset of symptoms, stop and rest. Wait a day or two until the symptoms have completely receded before continuing to climb.
Proactively, you can take Diamox one to two days before starting your climb. The medication reduces symptoms and eases your adjustment to altitude. If you’re still feeling the effects while climbing, try combatting headaches with ibuprofen and Tylenol. And promethazine can work wonders when feeling sick.
If you’re still exhibiting symptoms after 24 hours, turn around and start to descend. Once down at the base, the symptoms should dispel after two to three days. Don’t try ascending to high altitude again until the symptoms are completely gone.
Finally, if you’re experiencing symptoms tell someone. Your travel companions are there to help and will have clearer heads to assess the situation.
While it is a hindrance, if you monitor and treat the symptoms appropriately, altitude sickness should not be the reason you miss making it to the summit.
In today’s highly-developed world, gaining a competitive edge is more difficult than ever. Speed suits for swimmers, carbon fibre soles in running shoes, and aerodynamic helmets and bikes have become more and more available to recreational athletes looking to up their game. However, as fun and cool as these tech trends are, they don’t actually change the most important thing – your own personal human engine.
Within the millions of blood vessels in your body travel red blood cells, called erythrocytes. The role of these erythrocytes is to transport highly-coveted oxygen to tissues in order to power your body. If you decide to train for a marathon and get going on a training program, the body begins to produce more and more red blood cells over the weeks to be able to deliver more oxygen to starving muscles that are working harder and longer than in previous weeks. This is a normal response to training and one of the reasons why a long run weekly is very important! The quality of the red blood cells also begins to improve as each blood cell becomes larger and able to carry more oxygen molecules. You can notice these changes during a training program as distances that once would make you feel tired and out of breath become easier and less effortful.
The body is very smart and very insightful. In circumstances where oxygen is harder to come by, it will quickly realize that this special and limited resource needs to be used as effectively and as efficiently as possible. Studies have shown that at altitudes of 2100m and up, the number of blood cells in the bloodstream is higher, and size of red blood cells are bigger. In most basic terms – you can go harder and longer with the same amount of effort.
Now, because the body is so smart (and also lazy), the timing and consistency of training at altitude becomes important. Effects on blood cells can begin as early as 2 hours of exposure, and get better and better with time. If you’ve got a race coming up in a few months, you’ll want to spend about 24 hours total at altitude prior to in order to begin to see tangible changes. If you’ve really got your eye on the prize, the more hours that you can train, the better! Studies have shown that red blood cells increase in size after every 100 hours of altitude training.
Who can benefit from training high in the sky? Well, if you’ve picked a race that is taking place above sea-level, you are absolutely going to want to prep for it by getting yourself acclimatized. Even the most well-rounded training program done at sea level will lend itself to a sub-par race at altitude as the body will be starved for oxygen that isn’t available. Not to mention, it’ll feel fairly awful. Second, even if you don’t have anything high in the sky coming up, you’ll be able to truly maximize your training and body adaptations by getting into the chamber even once per week. More blood cells = more oxygen = more work with less effort. Hello PB!
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If you have been around endurance sports for long enough, you’ve definitely heard a coach, a training partner, or a Tour de France broadcaster mention something about red blood cells and how they are important for aerobic exercise. But, what are they, really? And how do they work?
Red blood cells (also called erythrocytes) are miniature concave saucers, and exist in trillions in our blood stream. Their main function is to carry oxygen from the lungs to the working muscles. They are important, because muscles need oxygen to perform aerobic exercise.
Red blood cells move oxygen with the help of haemoglobin, a red protein that gives the cells its colour. Millions of haemoglobin molecules bind, or grab, four oxygen molecules in the blood. Then, the red blood cells shuttle the molecules to working muscles.
Look at it this way: if we are oxygen, red blood cells are public transit. The more shuttles we have, the more efficiently we get to where we want to go.
The more red blood cells we have the more haemoglobin we can carry the more oxygen we can transport to working muscle the better our muscles exercise the slower we tire.
Recap: if you’re an endurance athlete, you want those red blood cells.
But, can we control the amount of red blood cells that we have? Can we train our bodies to make more?
Red blood cell count is in part genetically determined, but yes, it can be manipulated. The body can start producing more red blood cells when exposed to low-oxygen (or hypoxic) conditions. Here is how it works:
Does erythropoietin (or EPO) sound familiar to you? Think of Lance Armstrong confessing to Oprah about illegally using extra doses of it, nearly 10 years ago.
We don’t have to be doping to use EPO: we each have a natural source of this good stuff inside of us. When little oxygen is available in our surroundings, the kidneys secrete EPO, which binds to cells in the bone marrow that produce more red blood cells.
In short: Exposure to a low-oxygen environment can increase red blood cell count, and increasing red blood cell count can improve aerobic performance.
How to increase my own red blood cell count:
It is common practice to train at altitudes of 6,000 to 10,000 feet, in order to increase red blood cell count. Individuals can see an initial spike in red blood cell count as early as 24 to 48 hours after the first training bout at altitude, and tend to see a real change after three weeks to a month of low-oxygen training. That is why it is common to hear of athletes training at altitude for a month, before coming down to race. Read more about the science behind altitude training here.
How do I know if my red blood cell count is increasing?
A simple blood test can reveal your hematocrit, which is the ratio of your volume of red blood cells to the total volume of your blood. This value can reflect changes in your red blood cell count. We recommend that you regularly monitor your blood profile when training in a low-oxygen environment, so that you can understand how you are responding to the training.
Keep in mind: Before you experiment for yourself, know that changes in red blood cell count might vary with the elevation at which you choose to train, the fitness and training background of athletes, and the person to person variability of EPO production.
The bottom line: If you fancy getting faster, training up high and tapping into your very own natural source of red blood cells (I said natural, Lance) is absolutely worth a try.
If you are planning on taking your hikes to the next level, you have to be prepared. The effects of altitude can make your trek laboured and uncomfortable – at the very least. And at the very worst, they can ruin your trip.
Here are some things you can do to better prepare for attempting a high-altitude summit:
1. Build up your aerobic and anaerobic cardio systems
The goal here is to boost your VO2 max – which is a measure of the amount of oxygen your body can consume. Increased consumption allows more oxygen to be delivered to your muscles. This will allow you to generate more physical output for a given input, which will be especially key at higher altitudes – where it is more difficult for your body to absorb oxygen.
To increase your VO2 max, incorporate steady state cardio activities like running, cycling or swimming into your training regime. You can also try low-impact elliptical at the gym or the stair climber (higher impact – but does a really good job of mimicking the feel of trekking and adding power to your legs). For each of these activities, aim for at least 45 minutes of consistent work around 4 times a week.
You will also want to throw in 1 or 2 anaerobic (HIIT style) cardio sessions to challenge your max heart rate and get you used to that breathless feeling. The focus here is to do short intervals of timed work and rest (i.e 40 seconds on, 20 seconds off). During the work intervals, you want to be pushing yourself to an 8 or 9 out of 10 exertion level. Pick activities that allow you to reach this level in a short amount of time, like sprinting or plyometrics.
See if you can try some of these activities at altitude – whether it is a trip to the mountains to run some trails or doing finding access to simulated altitude training at home using masks, or even better, a high altitude training gym (Check out Tip 6 below).
2. Spend more time in the Weight Room
Expect it to be much harder for your muscles to power your body when there is less oxygen in the air. The more you can build up your strength beforehand, especially in your lower body, the more you will be able to endure. Focus on big muscle groups – quads (thigh muscles), glutes (butt muscles), back, chest and hamstrings. But also think about strengthening muscles that help with stabilization, like your core. When it comes to weight and reps – you want to think endurance based rather than sheer strength. This will mean lighter weights and more reps. See here for a sample 12-week workout plan that follows these guidelines.
Incorporate at least 3 strength training sessions into your weekly schedule. It’s especially important to work with good form – so get advice from a trainer or join a cross-training class for best results.
3. Learn some breathing techniques
We hardly ever think about our breath down here at sea level. At higher altitudes, however, the effects of decreased oxygen intake cause the breath to be laboured and shallow. So it’s not surprising to find breathing a focal point on the mountain. If you’ve ever been to a yoga class or tried meditation, you’ll know there are ways to control the depth, pace and frequency of the breath. Here are some breathing techniques that you can try on the mountain.
According to the Cleveland Clinic, pursed breathing has been shown to reduce how hard a person has to work to breath. It’s helpful to try during exercise. To do it: take two counts to breathe in slowly (doesn’t have to be a deep breath) through your nose with your mouth closed. As you breathe out, form your lips into a puckered or whistle position.
Since the diaphragm is the most efficient muscle when it comes to breathing – taking time to strengthen it through diaphragmatic breathing before your expedition will help you on the mountain. This technique has been found to “decrease oxygen demand” and allow you to “use less effort and energy to breathe”. To do it: sit in a comfortable position and place one hand on your chest and one hand below your rib cage. Inhale slowly, feeling your belly expand with your lower hand. Squeeze your stomach and purse your lips as you exhale feeling your belly contract. Note that your top hand should remain still the whole time.
4. Work on your diet
Certain foods contain dietary nitrates that support your cardiovascular system. According to the Journal of Applied Philosophy, beetroot juice was proven to help study participants exercise up to 16% longer. This stamina boost was attributed to physiological adaptations to blood vessels and muscle tissue caused by nitrates in beets. These favourable adaptations result in your muscles needing less oxygen to perform. You should be doing everything you can do to prepare your body for oxygen-deficient elevations – and if it’s as easy as drinking beetroot juice, all the better!
Humidity levels are lower at higher altitudes. According to the Wilderness Medical Society, you lose water through respiration at high altitude twice as quickly compared to sea level. In other words – you can expect to be needing to drink a lot more water up there than down here. Start increasing your fluid intake now to get your body accustomed to the feeling. Aim for 3-4 liters daily. Also be sure to drink before, during and after your workout. If you are looking for some good electrolytes to add try Nuun tablets!
6. Try Simulated High Altitude Training
Of course, the best thing you can do to prepare for your trip is to expose yourself to high altitude. Exercising, breathing or sleeping at hypoxia (an environment with reduced oxygen levels) will physiologically prepare you for these conditions (and reduce your risk of getting Acute Mountain Sickness) through simulated high altitude equipment. Examples would include personal-use equipment, such as altitude training masks (which would be worn during exercise) or altitude tents for sleeping. You can often order these pieces through companies that specialize in altitude training systems, such as Mile High Training or Hypoxico.
Alternatively, altitude training facilities are popping up in several parts of the globe, including London, Chicago and Dubai and especially in Australia, where they have been well established for a couple of years now in Sydney and Melbourne. These facilities are actual gyms with specialized hypoxic chambers or altitude training rooms containing various cardio machines and strength training equipment. Members can participate in group training classes or solo sessions to improve exercise capacity at altitude. Doing 2 classes or sessions per week for at least 6 weeks before your trip would be the ideal way to acclimatize and take advantage of the physiological benefits of intermittent hypoxic training.
7. Build your mental strength
In any situation where you find yourself under intense physical exertion, half the battle is against your mind. You’ll likely be telling yourself that you can’t do it, that you can’t even take another step. You’ll be feeling anxious – which will raise your heart rate and make your breathing even more shallow and laboured than it should be. Of course, sometimes it is physically unsafe for you to keep going. But sometimes it can be hard to tell whether it is your body or brain that is telling you to stop.
This is a skill to practice before your trip. Try some of these tips during your workouts:
· Listen to music (or have a song in your head) and focus on the lyrics or beat. This will distract your mind and lift your spirits
· Undermine the difficulty your workout. Even if you have set yourself a tough challenge, tell yourself things like “just one more hill”, “10 more minutes”, “I’m more than halfway through”, “today is an easier day”. Even if these things aren’t true or don’t feel true, they can go along way in relaxing your body and extending your threshold. Convince yourself it’s not that bad, and it won’t be that bad.
· Take intermittent, deep breathes – especially during long endurance-based sessions of work. These ‘cleansing’ breathes will act as a restart or refresh button to challenge cumulative mental and physical fatigue. Breathe in slowly and exhale fully every 20 or 30 minutes. Notice how your body feels after these breathes – clearer mind, oxygen going to your legs and an overall sense of regeneration.
Known as the “The Adventure at the End of the World”, this race takes place in southern Patagonia – with routes changing every year. Teams cover ground through “trekking, climbing, rope-related work, kayaking, mountain biking and backcountry navigation”.
Known as a “Summer Camp for Big Kids”. The altitude makes this race next-level. Over 6 days and 120 miles, you cross stunning scenery at various elevations going up to 12600 feet. This race is just as fun as it is challenging.
Known as “The Most Beautiful Marathon of the World”, the Jungfrau Marathon is 26.1 miles and climbs an elevation of almost 6000 feet. Starting in the beautiful city of Interlaken, the course takes athletes through alpine terrain that reaches its highest point at almost 7250 feet.
When: September 7th, 2019
Where: Swiss Alps
Dragon’s Back Race
Known as “The Toughest 5-day Mountain Running Race in the World”, this race challenges competitors through 196 miles of mountainous terrain that climbs over 50800 feet in the mountains of Wales. Experience with mountain running and ultra distance races is essential for completing this remarkable and testing challenge.
Known as one of the greatest trail running races in the world”, Tor Des Geants is a non-stop ultra-trail race experience that covers 205 miles at a total elevation of 7880 ft. The surroundings are truly spectacular – Italian Alps, the Gran Paradiso Natural Park and the Aosta Valley – but the challenge itself is extremely difficult – only 40% of racers finished in 2018.