I have been researching the impact that high altitude climbing will have on my body, what I can expect, what I can do to assist my body’s ability to cope, and importantly, to be able to recognise the onset of Acute Mountain Sickness in its more serious forms.
Acute Mountain Sickness, AMS as it is often referred to, is the effect the declining number of molecules of oxygen in the atmosphere has on our body as we ascend in altitude. It can range from a mild illness, to the more severe life-threatening forms of the illness, such as High Altitude Pulmonary Edema (HAPE), and High Altitude Cerebral Edema (HACE).
The latter two conditions require immediate attention and descent from altitude otherwise death is the most likely outcome.
I’m not intending to go into a great discussion on either, nor am I qualified to do so, but as part of my “journey to the mountains” and extreme altitude climbing I want to gain a better understanding of both conditions.
High altitude is defined as 5,000 to 11,500 feet, very high altitude 11,500 to 18,000, and extreme altitude as 18,000 feet and above. At extreme altitudes physiologic function will outstrip acclimatisation eventually.
My reading has taken me across a wide variety of topics, but the one that caught my attention was the connection between muscle and the requirement to fuel our muscles with oxygen when under exertion.
Over the years I have trained as a power-lifter for strength purposes and I have achieved results I am happy with. As a consequence I have grown muscularly and currently weigh-in around the 95 kilogram mark. This has given me a good power-for-weight ratio and has enhanced my speed on the kayak, and rowing machine over the short to mid sprint distances.
Power-lifting has helped me develop strong legs, especially my quads through the nature of the exercise; squatting, and dead-lifting. I can squat around 180 kilograms (400lbs) and dead-lift 220 kilograms (460 lbs).
Will this muscle help, or hinder me on the mountain as I trudge up the side of an 8,000 metre peak??
When exercising, the body, or more specifically the contracting muscles, have an increased need for oxygen, and this is usually achieved by a higher blood flow to these muscles. And herein lies the dilemma as I see it. Due to the less dense air at altitude the number of oxygen molecules for any given mass of air will drop. Consequently, mental and physical performance will decline. The larger the muscles, the larger the requirement for oxygen to prevent muscular fatigue…
So what can I do?
There is not a lot that you can do to prepare for the effect of AMS, some people will adapt and perform better at altitude than others, and this is hard to predict from one individual to another.
What I can do is decrease my muscle mass. Whilst that will mean a decrease in overall strength I can try and maintain the power for weight ratio balance.
The upshot of all this is that ahead of my climb in New Zealand in January, and later next year in Nepal where I will be climbing three 6,000 metre peaks, including Lobuche East, I will deliberately take around 12-15 kilograms out of my frame…
The climbs in Nepal will be done without the aid of supplemental oxygen.
Essentially, I will not change my training routine at all, I will maintain my same level of weight training, kayaking, rowing, and other activities. I have found the best way to control weight change, either gaining, or losing, is via the kitchen, and diet. In fact I won’t even modify my diet to any great extent, simply quantity control.
Xplore 
I hiked to the top of Kili in 2008 and was very concerned about AMS before I began. I friend had suggested taking Diamox (I think that was the med) as he had climbed Kili a few years ago and everyone who took Diamox was fine, while he didn’t and he felt terribly ill (he’s an ironman athlete). I took his advice and took my first pill on day 5 after reaching 15,500 ft and coming down with the worse headache of my life. Within about an hour, the headache was gone and I felt fine, other than some tingly fingers (a common side affect). I will tell you, I felt incredible the day I summited Kili — happy and healthy — while my climbing partner stumbled behind me like she was drunk and kept saying that she felt like she was going to die (she felt terrible). We both agree that while AMS can strike anyone at any time, the meds probably helped me stay feeling well.
For training, I also spent a lot of time swimming, trying to build up my lung capacity. Instead of taking a breath every 3-4 strokes, I’d take one breath per lap. Did it help? maybe. Of course, taking your time (something they don’t do on Kili…we were 5 days up and 1 day down) is the BEST thing for taking care of your body in high altitudes. Best of luck!
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Yes, Kili seems to get a higher incidence of AMS, due, in part to the speed at which it is done and without sufficient acclimatisation.
As you say, descending will help overcome AMS, and whilst not a magic pill, Diamox can help as you’ve described, although with some side effects. It has been known to cause blurred vision in some . It does require some caution as it does not remove the need to go to lower altitudes if you have ongoing and worsening AMS symptoms.
On the training front, I spend a lot of time on the kayak and C2 Rower, both for endurance and sprint work, and plenty of hill climbing with a 20-30kg pack. I find the latter is very useful as it mimics precisely what you will be doing, albeit not at altitude…
But I like your idea of swimming and breathing, mind you not sure I’d do the 50 metres on one breath – geez I’d drown! (You weren’t a fish in a previous life by chance?)
And thanks for the great input, appreciate you taking the time to post your thoughts…
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The highest altitude for me was on Kilimanjaro, and near the summit, I felt really ill. I’m interested about your comments about the prevalence of AMS on that mountain, because I’d thought that my body wouldn’t be able to handle altitude in Nepal. Here’s my advice: take it pole, pole (slowly, slowly), and under no circumstances eat a Mars Bar. I still can’t face Mars Bars after all these years…
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I think the inherent problem for some on that mountain is the speed at which it is done. Usually 5 or less days, so you end up with more people feeling the effects of AMS, and most will get it to some degree. In contrast, the program in places like Nepal takes account of the need to spend plenty of time acclimatising. And once in the mountains climbing during the day and returning to sleep at a lower altitude is key to the process.
And crikey, did I see you saying that you aren’t into the real adventure things!! Kili is a pretty good effort…
Mars Bars are fine for me, but Back Country cuisine (dehydrated food…oops I’m feeling sick)…
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I’ve had some great adventures: Kili, the West Coast Trail, river rafting the Zambezi, internet dating… I draw the line when people pull out the crampons and ice axes 🙂 (But I love reading about people who embrace the hardcore adventures of this world!)
And you’re right about the speed. I think we hiked Kili in 5 days: 4 days up and 1 down. (So maybe trekking in Nepal is a possibility for me!)
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Of course…but you will need crampons and ice-axe, maybe!
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When you are in the kitchen- juice fresh vegetables and fruit, it will give you the nutrients your body needs, less the fiber!
In the weight room – try balance and stability excersisrs to train the smaller muscles in the body. Also practice breathing exercises.
Good luck out there, it’s a brave climb- mind over matter.
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Oddly, Kilimanjaro tends to have more people suffering the effects of AMS and this is most likely due to limited acclimatization. Recently I was climbing with a New Zealander (8 times to top of Mt Everest) and he said that in all his time climbing he hadn’t seen so many with AMS then he did on Kili…Acclimatization is the key. Next year when I go into Nepal we will spend a lot of time acclimatizing, small altitude gains each day as we walk in to Loubche East…
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Yes, thanks for this, I’m a big fan of fresh fruit and vegetable juices. And for sure I’m need to do more work on the core…
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Very interesting information. I had an situation about 10 years ago visiting Yosemite. I contracted food poisioning while there and had to be hospitalized. Being a “flatlander” resulted in my becoming dehydrated very quickly (due to the change in altitude), to the point where after only 6 hours of illness I started going into shock. It was not fun!! It really is amazing how even 7000 feet can make a difference in how your body reacts to stress. Knowledge is power!
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Absolutely. AMS can occur at quite low altitude and the key take-away is that if you feel sick at altitude you need to assume it is AMS. Most people will suffer the effects at some stage, but it is key to recognise it so it does not develop into the more dangerous conditions. What is interesting for me is that I can control and influence much of the preparation, but there is little I can do to prepare for AMS, apart from acclimatisation.
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so what do you recommend for Mount Kilimanjaro climb???
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so glad that you are researching this so that you will do your climbs safely….
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Enjoying it BG, all part of the journey….
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I’ve gone hiking in various national parks in Western Northern American and only once was I high enough to notice any remote difference in how it affected my oxygen supply.
I couldn’t imagine training for something where I have to actually take that into consideration!
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Hey, if I was running that marathon you’re running they’d have me on oxygen at the end for sure!
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I was trudging up to 4000m + awhile back in Nepal which is relatively not that high. Years of weights in the gym has given me some mass and looking at my guide scurrying in front of me in his lithe body makes me wonder if my training was actually necessary haha. I think like what you say AMS affects people differently..I was fine during my trek while some Koreans who were in front of me were vomiting outrageously and had to descend. I am excited for your climb!
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Thanks…I think I will take some size out because it might be a factor…
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At 18,000 (highest I have been) feet the effects felt most were from the acetazolamide I had taken. Which was in hindsight an unecessary precaution as we had planned our acclimatisation properly, and followed the plan closely.
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Thanks, and often that is the case for many things. The medication is worse for you…in some cases!
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