The greater ranges of the world provide home to the highest peaks and the most breathtakingly magnificent scenery you’ll find anywhere, but they can also be brutal on the human body – Its hugely important to look after your health when trekking in the high mountains. In this article we summarise four common health issues affecting trekkers and how to avoid them so you can stay healthy in the Himalayas and enjoy the experience!
In previous articles we’ve discussed booking trekking trips in Nepal and essential gear, however, the most important thing to plan properly is how to look after yourself and your body so that you can enjoy these spectacular environments safely.
You’ll likely have a planned itinerary taking in multiple consecutive days of many hours continuous trekking in rapidly changing weather, temperatures and environments. The trekking will get tougher and it will take its toll on you. What are the common health issues people have when trekking? How do you prevent, and deal with these issues if they do happen to you?
Altitude can do some very strange things to you and make you feel particularly odd, or in more severe cases, very sick. If ignored AMS can lead to High Altitude Cerebral oEdema (HACE) or High Altitude Pulmonary oEdema (HAPE) – both of which can be fatal.
AMS can be very simple to prevent and treat however, if the early signs are recognised and acted upon – it is critical that you do not ignore any potential symptoms of AMS!
Anyone venturing above 2500m altitude could experience some form of AMS. The good news is that your body will adjust and acclimatise to the altitude over time. For some it will happen quickly and others more slowly. It should be possible for everyone to acclimatise properly given enough time.
And time is the most important thing to plan for.
As we gain altitude the air becomes less dense, the higher we go the less pressure there is. So, for any given volume of air, there are less oxygen molecules floating around when you go higher. You may find you are breathing more heavily to try to deliver more oxygen to your system, and also your heart rate may increase. These are both signs that the body is adjusting to a change in altitude.
The main signs you need to look out for when ascending are:
If you experience either of these, you should stop ascending immediately. Symptoms should improve within a few hours and if you feel normal again the following morning, continue to ascend, if the symptoms are the same or worse – the only proven way to improve the situation is to descend. If you are unsure about your symptoms the safest thing to do is descend – don’t try and wait it out.
A good rule of thumb for most trekkers is to aim to sleep at no more than 400m higher than the previous night once above 4000m.
Because of these reasons the very best way to prevent AMS is TIME. Slowly, Slowly wins the race. Do not try and pack in a huge itinerary with absolutely zero contingency days and excessive altitude gain, it could end your trek prematurely! This is a recipe for, at best, disappointment or worse, disaster.
This is easy enough to do if you plan your own itinerary within a schedule that suits you – see our guide to booking a trekking trip – but if travelling in a group we think it’s critical to check with them how many contingency days they have allowed and what their procedures are if you are affected by AMS and the rest of the group is not. Keep in mind that a huge part of Nepal’s economy is built around trekking and climbing and it’s a hugely competitive industry – out of necessity many agencies will have stripped out any extra days to keep the headline costs down.
This is one of the most widely discussed topics amongst online forums as well as many groups of trekkers in just about every teahouse we stayed in.
One thing was plainly obvious – there are huge amounts of conflicting information and wild myths surrounding this drug. Not only that, but it’s one that far too many people seem to believe allows them to just ignore AMS altogether and do whatever they like without concern.
My only advice here is – don’t get advice online – including from me! Go and see a medical professional, preferably with experience in high altitude medicine, and seek their advice on Diamox and its uses. Supplement that with a carefully considered and well planned itinerary with some extra days built in and you should be fine.
These two wonderful things carry everywhere, everyday. Do not neglect them! Firstly make sure you have well fitting, appropriate trekking shoes or boots that are well worn in and tried and tested on long hill days well before coming to the Himalayas or other high mountain range.
An often overlooked aspect of footwear are insoles – it’s definitely worth visiting a sport shoe fitting centre that can analyse your step and see if your arches collapse or roll in anyway. We see so often horrendously supported arches and it can cause all kinds of pain in the feet and legs on multi day hikes. I personally had issues with knee pain nearly every morning and since learning about properly supported arches I switched to using Superfeet Insoles (link) and within a few weeks the problem disappeared. I fully suspected some trouble in the Himalayas but didn’t experience any problems whatsoever.
Secondly – keep your feet well groomed. I get very sweaty feet over a long day, I’m sure I’m not the only one. Make sure that every day your boots and insoles are separated, aired and dried. While that’s happening I make sure I wash and thoroughly dry my feet, including cleaning all of your toenails and removing any sock fluff, trimming these too if needed. Finally using an athletes foot powder just makes sure to avoid any fungal problems – all sounds gross but its important to consider when those feet are going to be encased inside a warm boot for hours and hours day after day.
If you get any hot spots its likely a sign of a developing blister – either use a blister prevention stick, or put a blister plaster on it before It develops into a blister. If you do develop blisters, avoid popping them as the raw skin can be a prime location for infection, just put a blister plaster in place anyway.
Its very likely that most people will experience some minor loss of appetite while at altitude. I did. And I didn’t realise just how badly this had affected me until we got back to Kathmandu and it is something I really need to consider carefully before heading back to the Himalayas.
I ate at every meal time but found it difficult to finish a single portion. Often, I would eat half a plate of noodles before I felt full for example. It was easy to overlook at the time, I didn’t think much of it because I *was* eating. But of course your body is working twice as hard at altitude and I wasn’t getting anywhere near the calories I was burning. The result was a worryingly huge 7kg weight loss in two weeks! Considering I didn’t really have any extra to lose beforehand (I started out at 5’11 and 72kg) I was shocked to see myself when we got back to Kathmandu.
I don’t know for sure but I think I would have benefitted from eating much more often but in small high calorie portions. Perhaps I should have drip fed nuts but I often do back home in the hills… just didn’t seem sensible to carry the extra weight up the mountain.
Im not sure what the best answer is here, and its probably unique to each individual so I will just advise that you really try to monitor your calorie intake and keep the right nutrition going in.
Finally – stay hydrated! This can mean as much as 4 litres of water a day but there is no specific amount that works for everyone. A good indicator is to just watch the colour of your pee. It should be between clear and a light straw colour.
Taking your own water purification system such as the Steripen (Link) will save you a fortune (water can be as much as $4 a litre) and will save on a ton of plastic bottles needing to be disposed of.
An interesting fact we discovered during an AMS talk by health professionals from International Porter Protection Group www.ippg.net in Machermo, is that apparently 90% of visitors to Nepal will get sickness and diarrhoea at some point during their visit. We highly recommend attending these talks if your trek passes through Machaermo or Gokyo (they also do the talk there) – its usually 3pm daily in both locations and for a small donation to the charity you can test your blood oxygen saturation and heart rate which can be both informative and fun (if you are well acclimatised!).
Unlike most other countries where the cause is of sickness and diarrhoea is often viral, in Nepal, the cause is nearly always bacterial infection meaning its likely you’ll need some antibiotics.
Again, you should always seek advice from a medical professional but we discovered that many of the over-the-counter antibiotics available in Nepal are not effective as most strains of bacteria are now resistant to them. One exception would be Azithromycin which is thought to be effective against most strains of active bacteria in Nepal (at least at the time of writing).
Its also a good idea to carry some rehydration salts – if you do get ill up high it’s very easy to dehydrate extremely quickly. These can help you get the right minerals and salts back into your system. They might taste awful though!
Stay safe, plan well, look out for early signs of any small problems and address them before they develop into big problems and you should have an enjoyable and healthy trekking experience!
And lastly – please, please seek professional advice before taking any medicines or drugs!
(Disclaimer – I am not a medical professional. It is your responsibility to seek professional medical advice before taking any medicines or drugs. Any advice you chose to follow here is entirely at your own risk!)