A Guide to High Altitude Hiking
Hiking at altitude is specific, and there are several rules worth following to stay safe. Here's our guide on high altitude hiking, including tips on how to prevent altitude sickness, how to acclimatize, and overall to prepare your body and mind for higher elevations.
Before our first trip to Nepal a few years ago, we had never realized that high altitude hiking is a category on its own. We could picture ourselves climbing a narrow path relentlessly towards a mountain pass surrounded by jagged peaks, almost touching the sky, but we could not imagine how our bodies will react and how we will feel.
Yes, we could read about the importance of acclimatization and the danger of altitude sickness.
Still, coming from the Czech Republic, where the highest mountain Snezka has 1602 meters and having many experiences from multi-day hikes in Europe or New Zealand, we just could not believe that hiking at altitude could affect us that much.
You know, we are all young, fit and healthy, and nothing can catch us off guard, right, definitely not thin air.
Still, we followed all the advice, and although we had a few minor issues, in the end, we were able to finish the Annapurna Circuit and reach the highest point on the trek at 5416 meters above sea level.
One would say that once you have such an experience, you can lightheartedly travel anywhere in the world as you already know how your body will respond to the altitude.
You can even have a feeling that if you were healthy one time, you could expect absolutely the same course of events next time, and there's no need to follow acclimatization tips so strictly. Unfortunately, the opposite is the truth.
When we traveled a few years later to South America, where many capital cities such as Quito or Bogota lie above 2500 meters line (by the way, La Paz, the capital city of Bolivia lies at 3600 meters above sea level), and where getting to many points of interest require high altitude hiking, the combination of packed itinerary and many changes of elevation often took a toll on us and we had to take rest more often than usual.
Even mountaineers who climb the highest peaks in the world never skip the acclimatization part, although their limits are surely higher than ours, and they call the Himalayas or other destinations in the altitude home.
To prevent altitude sickness, which can develop into more serious cases such as HAPE or HACE, a traveler needs to follow series of steps during the trip and before the adventure begins.
Here's everything you need to know about how to prevent altitude sickness, how to get ready for hiking in altitude, including our tried and tested acclimatization tips.
WHAT IS HIGH ALTITUDE HIKING
Before we start talking more closely about acclimatizing and avoiding altitude sickness, you might prefer to define the term high altitude hiking.
Although we've put this post together with hiking in mind, you can use these tips even for sightseeing in high altitude or for short visits to a city that sits at a higher elevation than usual.
In general, anything above 2500 meters line is considered high altitude hiking or visiting a place at a high altitude.
It seems pretty low, right? But the truth is that some people can really start having breathing problems at 2500 meters - it is often genetic, but sometimes the combination of the altitude and stress or lack of sleep can do the job.
In our case, we started feeling the lack of oxygen from around 3000 meters.
What is really important to say is that every person reacts differently. No matter how many guides you read, the theory is one thing, but your own experience can be absolutely different. If you feel well at high altitude, great, carry on slowly.
If you have mild altitude sickness symptoms, they will most likely pass once you take time and follow all the acclimatization tips.
But if your symptoms are severe, it does not matter if you are 3500 or 5500 meters above sea level - it is time to realize that consequences of serious altitude symptoms can be fatal, and you should always be prepared to turn around and get lower as soon as you can. But more about it later.
BEST WAYS TO PREPARE FOR HIGH ALTITUDE HIKING
We've already said that there's really no way to get ready for high altitude hiking except for the acclimatization and hope that your body will adjust as clearly a previous experience does not work.
But still, we believe there's a way how to prepare. Does it sound contradictory? We do not think so. Let us explain it.
Everyone can get sick in the mountains, but we believe if your body is strong before the trip, it will fight with the altitude much better.
If you are tired after all day long hiking, then the altitude sickness can take you by surprise more easily because it will be combined with exhaustion.
But if you'll be physically fit, there's a higher chance you beat all the symptoms, and after a few days, you'll be ready to continue.
As usual, it does not work 100% of the time; having a jet lag in the altitude can make you feel terrible despite the level of fitness, but in the end, there's nothing bad about getting into shape and living a healthier lifestyle.
BE ACTIVE
Jogging, interval intensity training, or Nordic walking, or just simple walking are perfect activities for your cardiovascular system. Of course, if possible, once you get into it, try to include in your training program running hills or stairs.
Regular training is key, and you need to set your priorities right. If you know the trek will be challenging, start preparing at least one month before departure.
If you know that your main activity will be sightseeing, let's say in Cusco, two or three weeks should be enough.
WALK WITH A BACKPACK
If you are getting ready for high altitude hiking and do not plan on hiring a porter, it is essential to prepare for walking with a backpack on your back.
It is really very different to carry 10 kilograms on your back for two or three weeks, especially above 3000 meters, as the energy lowers quicker.
CLIMB AS HIGH AS POSSIBLE
If you have a possibility to get to the mountains before the trip, it can definitely help. 3000 - 3500 meters is the ideal altitude for acclimatization.
As many of us do not have this chance, instead, you have to plan acclimatization stay or day-trips at your final destination.
BREATHING EXERCISES
It is proven that yoga or any dedicated breathing exercises help when hiking in the altitude. Once you start feeling shortness of breath, keep a steady pace, and focus on your favorite breathing method. For me, it works to inhale and exhale for three counts.
Once you learn this in ideal conditions, it is much easier to apply this technique in more difficult situations.
DRINK MORE WATER
One of the key tips for preventing altitude sickness is to drink a lot of water. And you will hardly get from drinking half a liter per day (often my bad habit when sitting behind the desk all day) to drinking ideally 2.5 - 3 liters daily.
Learn how to drink frequently, and set a goal to drink at least two liters of pure water every day - it is actually healthy, and you can incorporate this habit into your daily routine even if you return from the high altitude trek.
BE OPEN TO LOCAL TIPS
When we were traveling in Peru or Bolivia, we could not but notice that local guides and porters all the time chew coca leaves. Apparently, coca works as a stimulant and suppresses mild fatigue or tiredness, and it is often used to prevent altitude sickness.
We drank coca tea regularly in these countries, and Martin even tried the chewing trick on Salkantay Trek, Inca Trail or Salar Uyuni tour.
We do not want to encourage you to do this, but it is good to know that local people have tricks that help them function in every high-altitude area, and it is only up to you if you decide to try them.
Just a short side note - you can have traces of coca in your blood for a few days; some people told us their company might test them for drugs after arrival.
ALTITUDE SICKNESS
It is very likely that you will encounter at least mild altitude sickness symptoms at high elevation. If not, consider yourself lucky, remember what you did, and retrace your steps one by one on your next adventure.
Altitude sickness is not very fair, as it can hit literally everyone - age, physical fitness, sex, or lifestyle - it does not play any role here.
Altitude sickness is caused by the change of the air pressure that results in the fact there is less oxygen your body can use. The higher you get, the less oxygen there is, which can cause problems.
In general, people can get used to it - people born in Manang at 3519 meters above sea level definitely have an advantage over people who live in Jordan near the Dead Sea.
What we found the most difficult is to stay at the altitude overnight. Usually, when we made a one-day trip, for example, from Cusco to Rainbow Mountain, or from Riobamba to Chimborazo, the hike was so short that our body did not have time to react badly.
Yes, we could not move so fast and breathed more heavily, but we never experienced the same headaches we had in Nepal, where the highest point where we had to spend the night was 4540 meters.
On the other hand, we heard about a few people who ended up in the hospital and apparently had an immediate attack of altitude sickness, so it is only our personal experience rather than advice - it is always better to acclimatize, no matter how long the trip is.
SYMPTOMS
What are mild altitude sickness symptoms? Usually it is a mild headache, nausea, it is hard to breath, you can’t sleep, you can be more tired and need more time to recover, lack of hunger, or problems with balance and orientation.
Remember that altitude sickness can be really dangerous.
So these symptoms should disappear after a day or two but should not get worse. If it gets worse, you need to act quickly, but more about it later.
HOW TO PREVENT ALTITUDE SICKNESS: ACCLIMATIZATION TIPS
It seemed to us that once we got above 3000 meters, acclimatization was the most important word in the world.
Everyone was talking about acclimatization, and we took it very seriously. If you want to increase your chances to finish a high altitude hike of your choice, you should take it seriously too.
We know it is hit or miss, but the following acclimatization tips really work.
And if your altitude sickness gets worse despite these tips, you will at least know you did everything you could, and there won't be any hard feelings.
By the way, when planning a high altitude trip, we always recommend to have a backup plan, just in case your body fails you.
It's the case even if you land in the city, which sits at altitude. You can plan a busy itinerary for the very first day, but it is also good to have an extra day or a trip to a lower elevated town nearby.
TAKE IT SLOWLY
Rule number one to avoid altitude sickness is to give your body a chance to adjust to the elevation. High altitude hiking is not a race, so plan your itinerary carefully and not think only about the distance and time on the road, but always incorporate in your planning the elevation gain.
Give yourself time; you don't have to start the hike right after arrival.
Also, be prepared that your pace will be likely slower than your regular pace, so do not get nervous. Hiking in the mountains is not only about physical performance, but it also helps your mental health.
Once on the trail, take regular breaks and set a steady speed.
MAINTAIN A BREATHING RHYTHM
We would have never believed how important it is to maintain a breathing rhythm. Once we were above 4000 meters, we got tired quite quickly, and our legs were heavy, so we had to push ourselves to dig deeper.
This was the moment when breathing exercise paid off.
DRINK A LOT OF WATER
Staying hydrated is one of the most important acclimatization tips. Your body in the elevation works harder; it needs more water because it also uses more water.
Make sure you have enough water before the hike or at least know there's a place along the way where you can refill water.
Sometimes the water from the streams is drinkable but not always, so consider buying a water bottle with integrated filter or SteriPen (and you also lower your plastic footprint).
It is also recommended to add to the water electrolytes that help to rehydrate your body faster than pure water.
EAT REGULARLY
Same as your body use up more water, it also needs a lot more energy. The problem is that many people high in the mountains do not feel hungry.
When hiking at a high altitude, it is not the time to stick to your well-balanced diet; on the contrary, you should focus on eating high protein and carb snacks.
Don't worry about stocking up on chocolate or energy bars; you will burn the calories easily.
DO NOT DRINK ALCOHOL
Alcohol dehydrates, and your body does not need to be weakened in the high altitude; that's why you should avoid alcohol during the length of the trek, but also a few days before.
The same goes for cigarettes and drugs.
CLIMB UP GRADUALLY
The golden rule on how to avoid altitude sickness lies in climbing up gradually. In general, up to 3500 meters, you can walk as fast and gain as many meters as you like.
But from this point, you should not gain more than 300 to 600 meters per day. Gradual acclimatization is the best as your body has time to adjust to the elevation.
We found hiking the Annapurna Circuit anti-clockwise perfect as we started in Besisahar, located below 800 meters, and we climbed steadily to more than 5000 meters, so we were prepared to cross the Thorong La, the highest point of the entire trek.
The advantage was that this trek was dotted with guesthouses, but we know that not all multi-day hikes have such a luxury. If you know in advance that gradual acclimatization is not possible, always weigh the pros and cons and be aware of risks.
SLEEP LOW
Sleeping is an important part of hiking in the altitude, and recovering after the whole day of trekking helps prevent altitude sickness.
Another important tip is that you should always sleep at a lower altitude than the highest point you reached on the trail.
If the trek's profile climbs steadily uphill and your accommodation is not located lower, consider taking a short trip to a nearby hill before you go to bed.
SLEEP A LOT
Sometimes, we found it quite hard to sleep in the altitude because the sleep was very light, and we often woke up because of the lack of oxygen.
Even if you cannot sleep, do not get up, and try to doze off as the rest is super-important. If possible, do not take sleeping pills.
BE ACTIVE
Although acclimatization days are essential, it does not mean you should spend the whole day in bed. It is actually not the best way how to acclimatize.
Even if you decided to stay put in one place to rest and adjust to the altitude, it is recommended to take at least short acclimatization day trips.
KEEP YOUR BODY COMFORT
To acclimatize well, make sure you feel comfortable. Getting sunburnt is very common in the mountains, so always apply a high SPF sunscreen and lip balm.
Wear functional clothes, and make sure you have extra layers so you can always change into a dry t-shirt and trousers.
Simply put, make your life at high altitudes easier.
KNOW YOUR LIMITS
The line between mild altitude sickness and severe problems is often fragile, and your motivation to finish the hike should never threaten your health.
Knowing your limits is the key and many experienced mountaineers who spent many years in the mountains said that the reason they still live is their ability to recognize when it does not have the sense to carry on, and they know it is time to turn around.
Although we talk here about hiking in the altitude, not about conquering 8000 peaks, the logic is very similar.
HOW TO TREAT ALTITUDE SICKNESS
It is a fact that the majority of hikers experience a mild altitude sickness, and it does not mean they stop hiking. For many, it is enough to slow down, make acclimatization trips, sleep well, drink a lot of water, and wait for the symptoms to disappear.
But what if it does not happen? Is there a way how to treat altitude sickness?
First of all, if the symptoms did not go away, give your body more time - it can be two or three days. Your medical kit should also contain ibuprofen for headaches, and some hikers recommend Diamox or Dexamethasone.
We had these pills as well, but honestly, we would not take it to prevent altitude sickness but had it in our backpack if the illness gets worse, and we would have needed to get immediately to the lower elevation.
If you still feel that the symptoms do not disappear and what else, you feel even worse, you need to descend to the lower altitude as you probably have AMS (Acute Mountain Sickness). You can stay there for one or two days, and at that time you should start feeling well, and you can continue with the ascend.
Make another acclimatization trip and stay at the altitude where you had problems before - if your headache and nausea come back; it is, unfortunately, time to admit that this time this is your limit.
This is very important. If you do not listen to your body and want to carry on to higher altitudes, your sickness can turn into HAPE or even HACE, which are life-threatening conditions.
HAPE (High Altitude Pulmonary Edema) affects hikers' lungs as there gets a fluid that makes normal breathing impossible. Symptoms are shortness of breath even during inactivity, chest pain, and dry cough.
HACE (High Altitude Cerebral Edema) is even more dangerous because the fluid gets to the brain, and symptoms include disorientation and overall a very confusing behavior.
These altitude sickness forms are common in really high altitudes but can happen even in lower elevation due to insufficient acclimatization.
The only way to treat this sickness is to get immediately to a lower altitude and call medical help as consequences can be fatal.
HIGH ALTITUDE TRAVEL INSURANCE
This brings us to travel insurance. We think every traveler should have travel insurance as it is a responsible thing to do, but in the mountains, especially if you know you'll be hiking at high altitude, it is absolutely crucial.
All sports activities can be dangerous, but altitude sickness can develop quickly, and the fact you never know how your body will react makes it a real threat.
Rescue actions in the mountains are costly (we are talking in thousands of dollars), especially above 4000 meters, as it usually requires a helicopter.
If you're about to purchase travel insurance, make sure it includes sports activities and rescue from the elevation you plan on hiking at.
World Nomads provides travel insurance for travelers to cover their trip essentials, including sports and adventure activities.
SafetyWing is affordable travel insurance for backpackers, long-term travelers, and digital nomads.
Travel smarter and safer!
Travel Resources
Here you can find links to all the travel resources we use and which you might find helpful when planning your next holiday.
Accommodation: When looking for accommodation, we usually search hotels via Booking.com or Hostelworld.
Tours: Although we love to travel independently, some places are better to visit with a guided tour.
We prefer GetYourGuide for its easy-to-use interface and solid reputation. Another great alternative is Viator.
Rental Cars: When going on a road trip, we always use Rentalcars.com, a reliable site for booking a rental car in advance.
Flight Tickets: When looking for flight tickets, you can search Skyscanner to find the best price.
Travel Insurance: World Nomads and SafetyWing cover against risks of travel.
