I have discovered a love for high altitude travel that makes my poor, altitude-hating husband want to cry. Something has changed since my horrendous five-steps-at-a-time hike over Dead Woman’s Pass on the Inca Trail left me nauseous, stumbling with lassitude, and struggling to take each breath. Nowadays, my body rarely struggles against the thin air, my head does not ache, and my stomach appreciates my newfound respect for light meals.

While my husband treats high altitude with similar respect, his body does not always respond in a positive way. Having an altitude-sick traveling companion can be frustrating for friends and family, especially for those that don’t feel a thing. But struggling at high altitude rarely means the end of your trip.

What is High Altitude?

Doctors consider any location over 4,900 feet (1,500 meters) to be high altitude. Very high is 11,500 feet (3,500 meters) and extreme is anything over 18,000 feet (5,500 meters).

Let’s put those numbers into American perspective.

The highest city in the United States is Denver at 5,280 feet (1,609 meters), nicknamed the Mile High City for good reason! Quito, Ecuador, the second-highest capital city in the world, lies at 9,350 feet (2,850 meters), not quite twice as high as Denver. Nearby tourist destinations in Quito like the Teleferico (13,451 feet or 4,100 meters) and the Refugio at Cotopaxi National Park (15, 744 feet or 4,800 meters) easily qualify as very high altitude.

How High Altitude Affects Your Body

As our blood pumps through our veins, it takes oxygen that we breath in and distributes it to our muscles to help them work. The higher we take our bodies, the more difficulty our body has absorbing oxygen. The less oxygen, the harder our muscles have to work. That’s why a task like walking up stairs can feel more difficult at higher altitude. Your muscles have to do the same amount of work but with less oxygen to assist. You’re going to feel your lungs struggle to take a deep breath, your heart to pump faster, and your muscles to ache more.

Because your muscles require extra attention to operate at high altitude, other systems tend to slow down. Often blamed on drinking tap water or eating poorly-washed raw veggies (which can both be a problem), stomach issues like bloating, diarrhea, or constipation are normal, especially the first couple of days at altitude.

Many people also struggle with headaches at high altitude. A large part of what they feel is dehydration. The combination of high mountains, quick evaporation of sweat so that you don’t notice how hard your body is working, and the lack of easily drinkable water straight from the tap all add to the danger.

In rare cases, a person might experience fever and vomiting. Our youngest son experienced this while visiting Lake Titicaca in Peru. We were able to control his symptoms with medication bought at a local pharmacy. We were not aware of the relationship between dehydration and altitude and could have taken steps to prevent some of his worse symptoms.

What Are The Symptoms of High Altitude Sickness?

True high altitude sickness, also called Acute Mountain Sickness (AMS), is dangerous and life-threatening. Most visitors to the Andes never experience it. But if you are visiting locations in the very high to extremely high altitude range, you need to be aware of these symptoms.

One or two symptoms alone are not a big worry. Three or more and it is important to get to a lower altitude, hydrate, take medication, and rest. Worse case scenarios lead to HACE or High Altitude Cerebral Edema, so if symptoms are not going away with simple measures, head to the emergency room.

Headache

This is not just a standard headache. It may start as a dull ache but will end up feeling like a vise has gripped your skull. And medication may dull it but not take it completely away.

Lassitude

Your body just doesn’t want to move. You would be happy to sit down in the middle of the trail and just stop hiking.

Drowsiness

All you want to do is go to sleep. This is lassitude in the extreme.

Nausea

You feel like throwing up or are actually doing it. From my experience, it’s like being on a never-ending boat trip on the high seas.

Lack of Coordination

If you find yourself stumbling and tripping along the trail, you are likely feeling the effects of altitude.

Confusion

This is hard to recognize in yourself but if your friends and family are not answering basic questions with straightforward answers, don’t understand where they are or what they are doing, get them down the mountain and to a doctor.

How To Tackle High Altitude Travel

Ask your doctor for a prescription for acetazolamide (Diamox) before arriving at your high-altitude vacation destination. This medication is not for everyone and I recommend reading all of the side effects before taking it. However, it is effective for some people. I tried it once and hated it because it made food taste strange.

If you have these pre-existing medical conditions, please consult your doctor BEFORE traveling: heart disease, arrhythmias, congenital heart problems, fluid retention side-effects from heart failure, pulmonary hypertension, asthma, emphysema, cystic fibrosis, seizures, and brain tumors. Consider seeing your doctor if you have high blood pressure or suffer from migraines. For more information, check out the Institute for Altitude Medicine website.

1. Hydrate BEFORE you travel

A good week before you get on that airplane, make sure you are drinking lots of water. Every cell in your body needs to feel hydrated before you get on that plane.

2. Hydrate while flying

I know it is a pain to visit the bathroom on a flight but arriving at a high altitude destination already dehydrated is a guaranteed way to experience the headaches that hit so many visitors.

3. Hydrate while traveling

Keep drinking plenty of liquids throughout your entire trip. While you don’t need to avoid alcohol, do limit how much you drink. The symptoms of high-altitude sickness and a hangover overlap and you don’t want to place yourself in a situation of not understanding which your body is fighting. High altitude sickness is life-threatening and no joke.

4. Pre-medicate

Upon arrival, take your favorite headache medication, even if you don’t feel a headache. Take it with an entire bottle of water. This will help prevent that first headache, often so hard to get rid of once it arrives. It will also help with achy muscles that come from working harder at high altitude.

5. Eat small meals

Because your stomach is likely to struggle at altitude, at least the first couple of days, treat it with respect. Eat lightly and consider eating lots of soup rather than heavy foods.

If hiking at high altitude, consider skipping meals and eating high energy snacks instead. I’ve also found a thermos of hot tea can do wonders. Whether it is the shot of caffeine or the additional liquid that makes a difference, I’m not sure.

6. Consider local remedies

Every location has a local remedy for high altitude. In Peru, drinking coca tea has become an almost time-honored tradition, especially on the Inca Trail where your porter might greet you with a cup each morning. In Ecuador, some people swear that chocolate helps and others insist on sopa de gallina criolla (chicken soup). Our guide on the Inca Trail, Fredy Zapata, took an evening shot of whiskey to thin his blood and help him sleep better.

None of these will actually help with true AMS but with high altitude adjustment, none of them hurt and some of them might actually help.

7. Postpone the Highest Altitude Day Trips

If you or anyone in your group feels the effects of high altitude, don’t go higher. If you must, have a backup plan if symptoms start to look like those mentioned above. Preventing true altitude sickness is worth changing your plans.

In closing, I just want to point out that many people never have problems at all. As Inca Trail guide Fredy Zapata told me, he can never guess who will struggle and who won’t. Come prepared, take precautions, and give your body a fighting chance to do well.