Live Longer: Acute Mountain Sickness

This summer, the Telluride Ski Resort and The Peaks Resort & Spa are hosting a series of week-long wellness intensives under the banner of Live Longer Retreat. The Big Idea is to support your (recurring) New Year’s resolution to get really healthy and therefore live longer – and well.

The intensive includes personal consultations, talks and demonstrations related to nutrition, hiking, Pilates, spinning, yoga and more.

Dates this summer are June 3 –  June 9; July 15 – July 21; August 19 – August 25; and September 27 – September 30.

The program is led by Dr. Alan Safdi, a world-renowned internist and gastroenterologist with encyclopedic knowledge of mind-body wellness and preventative medicine. Dr. Safdi also has a gift for delivering evidence-based medical findings for healthier living in easily digestible sound bytes.

In the run-up to the retreats, Dr. Safdi is posting regular updates on Telluride Inside… and Out based on the latest, closely vetted research about subjects in the field of health, wellness and longevity. 

This week, Dr. Safdi  talks about acute mountain sickness. 

Feel free to sign up now to participate in a Live Longer Retreat   or call 1-877-448-5416 for further information.

Planning to hike this summer or ski this winter? All visitors to Telluride should know the signs of acute mountain sickness and its symptoms.

Learn the early signs of altitude sickness and be willing to admit that is what you are experiencing.

There is a myth that fitness drives your risk. But the truth is acute mountain sickness is based on your genetics, which has little to do with whether or not you are in shape.

If you are genetically predisposed, gong quickly from low to high altitude can cause headache, fatigue and nausea.

Acute mountain sickness affects more than one in four people who travel above 3,500 meters, or 11,600 feet, and more than half of those who travel above 6,000 meters, or 20,000 feet. Telluride Mountain Village is at about 9,500 feet. but a lot of the surrounding peaks and ski trails are much higher.

When they first get to the higher altitude, a significant percentage of people notice shortness of breath with exertion, also often a headache. Remember at 9500 feet the effective oxygen is about 29 percent lower. Although air contains 20.9% oxygen at all altitudes, lower air pressure at high altitude makes it feel like there is a lower percentage of oxygen. That would make your effective oxygen inhaled percentage feel like 14.8 percent rather than the almost 21 percent at sea level. No wonder we up here experience shortness of breath with exertion.

At 12,000 feet (3,658 meters), the barometric pressure is only 483 mmHg, so there are roughly 40% fewer oxygen molecules per breath. In order to properly oxygenate the body, your breathing rate (even while at rest) has to increase. Being fit may not prevent altitude sickness, but since there is less effective oxygen a really healthy person has a better chance of a more enjoyable trip from the get-go.

If possible, start a fitness program or kick things up a notch well before a trip to altitude because trying to get fit at higher altitudes can be difficult.

For skiing, certain exercises can be beneficial, and can be done without any equipment from the comfort of your home: stability balls or Bosu balls can maximize those efforts. Remember to start well before your trip – but consult a physician first.

A few of those exercises to prepare the body for skiing or hiking include:

1. Jump rope, starting at 1 minute and building to 3 minutes.

2. Run sprints in your neighborhood, on a track or on a treadmill. Downhill skiing is a lot like sprinting, but with short bursts of vigorous exercise.

3. Lunges work too.

4. Squat, but make sure not to extend your knee over your ankle.

Balance exercises are also helpful and never forget your core.

Also stretch before and during your trip. Using a foam roller or exercise band to facilitate may help muscles recover faster.

Altitude is defined on the following scale: High (8,000 – 12,000 feet [2,438 – 3,658 meters]); Very High (12,000 – 18,000 feet [3,658 – 5,487 meters]); and Extremely High (18,000+ feet [5,500+ meters]).

Telluride is not unique when it comes to the problem of altitude sickness. Other ski areas with high elevations include: Arapaho Basin, elevation, 11,000 feet; Breckenridge, elevation – 9,603 feet; Copper Mountain, elevation – 9,712 feet; Dillon, elevation – 9,111 feet; Frisco, elevation – 9,075 feet; Keystone, elevation – 9,280 feet; Loveland, elevation – 10,800 feet; and Silverthorne, elevation – 8,730 feet.

Headache, fatigue, some loss of appetite, nausea, vomiting, light-headedness and insomnia that develop 6 to 12 hours after ascent to  higher altitudes all can be symptoms of acute mountain sickness.

The problems usually improve in one or two days if the traveler does not go higher. In less than 1% of cases, symptoms can grow worse and turn into high-altitude cerebral edema.

Once a person adapts to higher elevations, there is an increase in red blood cells. Red blood cells known erythrocytes is what carries the oxygen in the blood and since we are inhaling less oxygen molecules we need more oxygen-carrying capacity. Our heart rate also increases to supply more oxygenated blood to the tissues. That is  most noticeable the first several days.

How do we mitigate or prevent some or all of those potential problems?

If going to the mountains think about spending a day or two at a lower altitude.

Acclimatize gradually.

Denver is at 5,280 feet and Santa Fe is at 7,000 feet. Both towns are great places to spend a day or two prior to your mountain adventure in Telluride.

If going on a significant trekking trip, the Centers for Disease Control advise no more than 1,000 feet of elevation gain per day at altitudes above 12,000 feet.

Not only should we also avoid alcohol at altitude for the first few days, we should start avoiding booze 48 hours prior to that trip. We should be extremely well hydrated the first several days – but not with alcohol.

Drink lots of water. High elevations can cause fluid loss, so it is important to stay well-hydrated. Stick with water or liquids that replace electrolytes. Avoid sugary or caffeinated beverages such as soft drinks. Sleeping pills may be contraindicated. You very well may notice increased urination for a couple of days. That is one response to changes in your body’s acid/base balance and helps the acclimatization process.

Also take it easy the first couple of days. Avoid tobacco as well as alcohol and depressant drugs including barbiturates, tranquilizers, and sleeping pills. Depressants further decrease the respiratory drive during sleep, resulting in a worsening of the symptoms.

Make sure your are eating a very healthy diet, including healthy carbohydrates. Your appetite may decrease at altitude, but try to take in an adequate amount of healthy calories. Have healthy snacks available.

What are the basic treatments of acute mountain sickness?

The only cure is either acclimatization or descent to a lower altitude.

Some of the symptoms can be treated with pain medications for headache (like acetaminophen or low dose short term ibuprofen like agents) and Diamox (Acetazolamide).

Diamox allows you to breathe faster so that you can metabolize more oxygen, thereby minimizing the symptoms caused by poor oxygenation.

The drug stimulates breathing, raises blood oxygen and increases urination, which is especially helpful at night when respiratory drive is decreased. Since it takes a while for Diamox to have an effect, however, it is advisable to start taking that medication 24 hours before going to altitude and then continue it for at least five days. The Himalayan Rescue Association Medical Clinic recommends 125 mg. twice a day (morning and night.) The 250 mg dose was not more effective. Possible side effects include tingling of the lips and finger tips, blurring of vision, and alteration of taste. But the side effects subside when the drug is stopped. Since Diamox is a sulfonamide drug, people who are allergic to sulfa drugs need an alternative.

You can buy or rent oxygen concentrators. Using oxygen at night may help considerably.

It is amazing how many changes take place in the body to allow it to operate with decreased oxygen. What we discussed here is the most common form of altitude sickness, which is usually mild. More severe forms include High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE), but they are rare and beyond the scope of this post.

As a precaution, be sure you discuss all recommendations in this story with your health care provider.

More about Dr. Alan Safdi:

Dr. Alan Safdi is a board-certified in Internal Medicine and in Gastroenterology and a Fellow of the American College of Gastroenterology. A proven leader in the healthcare arena, Safdi has been featured on the national program “Medical Crossfire” and authored or co-authored numerous medical articles and abstracts. He has been an investigator in over 581 studies and is President of both the Consultants For Clinical Research and the Ohio Gastroenterology and Liver Institute.

Dr. Safdi has been involved in grant-based and clinical research for about 35+ years and is passionate about disease prevention and wellness, not just fixing what has gone wrong. He lectures internationally on the subjects of wellness, nutrition, and gastroenterology.

More about the other lectures:

A series of lectures given by Dr. Alan Safdi and Dr. William Renner in Telluride is planned for the Spring. The talks on health, wellness, and longevity research target health care providers as well as the general public.

A new workshops targets the veterinary world with lectures and hands-on training for veterinarians in the field of endoscopic therapy in animals. Multiple stations with direct hands-on learning with in-depth lectures with regards to GI disease that can be treated or prevented with endoscopic therapy.

For more information, visit the following websites:www.wellnesstelluride.org/; www.animalendoscopy.com; and www.tellurideCME.com

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