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How to treat altitude sickness naturally: 9 Ways Trekkers Can Deal With Acute Mountain Sickness (AMS)

How To Prevent Altitude Sickness Using Natural Remedies

For worriers like me, altitude is a huge concern. As someone with no experience of high altitudes previously, when I hear the words ‘altitude sickness’, the first thing that jumps into my head climbers attempting to summit Everest and dying en route. Unfortunately for me, that is just how my brain works. 

It would be fair to say that I hadn’t really planned for the extreme altitudes that South America is most famous for. I brought no medication with me and instead used only natural remedies for altitude sickness. Luckily, this worked a treat. It may surprise you but there are actually loads of natural remedies for altitude sickness out there. 



This article has been written using my own experience. Although it is also the result of many hours of research, I am not a medical professional. I would always advise travellers concerned about adapting to altitude and avoiding altitude sickness to speak to their doctor.  

What is altitude sickness? 

According to the Fit for Travel website, altitude sickness is defined as ‘when the body fails to or has not had enough time to acclimatise to altitude’. High altitude generally covers anything over 1,500 metres above sea level (m.a.s.l.) however, altitude sickness can occur anywhere from 2,400 ma.s.l. At best it is uncomfortable and at worst, downright dangerous. 

Altitude sickness can be dangerous so it is important to be able to recognise the signs.

There are varying levels of altitude sickness, however, most people are likely to experience feeling nauseous, light-headed or dizzy. In my own experience, these have been the symptoms that I have suffered from the most. In its mildest form, altitude sickness is known as acute mountain sickness (AMS). 

As well as the symptoms listed above, travellers suffering from altitude sickness could also suffer from dehydration, shortness of breath, headache and lack of appetite. More serious cases of altitude sickness can result in fluid building up in the lungs (High-altitude pulmonary edema) or brain swelling (High-altitude cerebral edema). Unless treated immediately, these symptoms can result in death. Altitude sickness is a scary thing for sure!

Who is affected by altitude sickness? 

Anyone can be affected by altitude sickness as you can never predict how your body will deal with altitude. It is something which plights the young, old, fit and healthy. You may find that you go to an area of high altitude once and be absolutely fine but feel terrible when you return to high altitudes.

Doing anything at high altitudes requires more energy and physical exertion. You actually burn far more calories at high altitude than when you are at sea level, even when you are resting. 

20% of people will be affected by altitude sickness at around 2,500 m.a.s.l. but this percentage increases to 40% once the altitude has risen to 3,000 m.a.s.l. As a result of this, it is wise to be wary of extreme changes in altitude because it is likely you could be impacted in some way. 

Even the most simple of tasks require more exertion at high altitude.

Whilst many travellers decide to try and offset the symptoms of altitude with pills, I found that during my time backpacking South America, all I needed was a few natural remedies which really helped with the symptoms of altitude sickness.  

How to prevent altitude sickness naturally: 

As with anything, prevention is better than cure and these steps should be carried out in advance of you arriving at the high altitudes. 

  • Start to physically prepare

Although even the fittest people can fall victim to altitude sickness, people who are not in shape are still at a greater risk. If you are planning on visiting cities which lie at high elevations or doing a demanding hike like the Salkantay trek in Peru, it is worth cramming in a bit of training before you leave. The more physically able you are, the more of an advantage you will have when dealing with the altitude. 

Even if you do end up feeling sick and getting other symptoms, at least it is only the altitude that you will need to worry about instead of your ability to do the hike itself.  

In order to help your body adapt to the change in altitude, you will need to drink a lot of water. Therefore, training your body to become used to a larger water intake will be beneficial once you are at high altitude.

Staying hydrated is necessary to help adapt to high altitude.

  • Make sure you have packed what you need

When it comes to hiking at high altitude, you will need to make sure that you have adequately planned ahead and are carrying everything you need. Water is an absolute must when traversing area at high altitudes as are snacks to boost your energy. Make sure you pack a daypack with everything you need in advance. 

Best natural remedies for altitude sickness:

  • Take time to acclimatise 

The people that I met around south America who were most commonly caught out with altitude sickness were the people that had flown into high cities and not allowed themselves the time to acclimatise to the conditions.  

The NHS recommends that you should allow at least 2-3 days to get used to high altitudes before ascending over 3,000 m.a.s.l. whereas, other medical organisations suggest at least a week. From my personal experience, I found that allowing a few days was definitely not enough when I tried to tackle Pichincha volcano which stands at 4,784 m.

Here I am, loving my hike up to Pichincha volcano.

  • Try to sleep at lower altitudes

High altitudes are a big sleep stealer. Low oxygen levels can affect your breathing during the night which in turn can make you feel suffocated. This coupled with frequent waking, can leave you feeling grouchy and unrefreshed the following morning. 

Remaining hydrated is definitely one of the best ways to avoid altitude sickness naturally. Do not wait until you feel thirsty as this will be too late. 

Altitude can make you want to pee more so you will lose more water than usual because of this. You also lose more water when you breathe at high altitudes. This is a direct result of the lower oxygen levels which cause you to breathe more rapidly and more deeply. Surprisingly, you can actually lose twice as much water breathing at altitude as you can at sea level!

The final point links to sweat. Humidity is lower at high altitudes which means that your sweat will evaporate quicker. As a result, it can be very hard to judge how much water you are actually losing as a result of the exercise. 

A balanced diet is the way to go with anything in life but your body will definitely thank you for adding in a few more carbs than usual if you are spending a lot of time at altitude. The main reason for this is that carbohydrates require less oxygen for digestion than other fats. 

Just like with water, you should make sure that you are eating regular meals and snacks, even if you are not hungry. One of the symptoms of altitude sickness is loss of appetite so it is very important to push through this to keep your body fit and healthy.  

Carbs require less oxygen for digestion.

If you are hiking at altitude, you should definitely treat the journey as a marathon and not a sprint. It is generally suggested that hikers should not ascend more than 300 – 500 m over a 24 hour period. On top of this, medical professional advice says that for every 1000 m you climb, you should spend an extra day acclimatising. 

As much we would all love to rush the process, the safest way to deal with an increase in altitude is to allow your body the time to get used to it. Don’t do what I did during my Pichincha hike and just hope it will get better, chances are that it won’t until you come back down!

Through some slow and steady deep breathing, you can increase your oxygen levels. Yoga fanatics are likely to find this significantly easier than the rest of us but once you have mastered these techniques, you may find that it is useful in a number of other physically stressful situations. 

  • Consider using a herbal supplement 

There are a couple of herbal supplements that come highly recommended by professionals and travellers alike. The first of these is Gingko Biloba. This natural supplement is derived from the leaf of the Ginkgo tree and has been used for thousands of years to treat a range of conditions. Some scientific studies have shown a link between taking this supplement and experiencing a reduction in the symptoms of altitude sickness.

Coca leaves are also a popular choice within Andean communities to stave off the effects of altitude sickness. In countries such as Peru and Bolivia, coca products are very easy to buy. You can consume coca leaves in tea, sweets and chocolates, to name a few options. 

Coca leaves: The best natural remedy for altitude sickness?

Chewing the coca leaves raw is also a favourite way for many to fend off the effects of altitude. This tends to be the method preferred by the locals although it is less than pleasant. Personally, I did not enjoy the bitter taste of the coca leaves or the tingling cheeks that I got as a result of chewing. Saying that I definitely felt an energy boost when hiking and suffered less with the altitude when I was chewing coca as opposed to when I was not.  

  • Avoid drinking alcohol or caffeine 

Both alcohol and caffeine can dehydrate you so they are best avoided when you are living or exercising at high altitude. Any other substances that depress your breathing should also be avoided which means that smoking is out as well. 

The only guaranteed cure for altitude sickness is descent. If you begin to feel very ill or start vomiting, make you way back down to a lower altitude as soon as possible. If this is not possible for whatever reason, use an oxygen tank if there is one nearby. 

Many tour agencies which specialise in high altitude areas will carry oxygen tanks in case of emergency. During my three-day jaunt around Salar de Uyuni in Bolivia, the guides carried oxygen tanks as a precaution. Although I was lucky and didn’t need to use them, I met other travellers who did!

High altitude locations offer some stunning views- if you can get there!

Herbal supplements as a natural remedy for altitude sickness

During my travels, I have come across people who claim to have used Ginkgo Biloba to alleviate the symptoms of altitude sickness. It works by increasing your circulation and by thinning the blood. This can mean that despite being a natural remedy, it can be dangerous when mixed with other drugs. If you are using anticoagulant drugs, the mixing with Ginkgo Biloba can cause excessive bleeding which can be very dangerous. 

As well as Ginkgo Biloba, coca leaves are also used by locals and tourists alike to help treat altitude sickness. Although coca leaves have been proven to help with the symptoms of an increase in altitude, they are illegal in many parts of the world (they are the main ingredient of cocaine) and the penalties for carrying them are very harsh. 

If you have been using coca leaves in South America, make sure you discard of any leaves, sweets or teabags before attempting to board a flight or leave the country. In the eyes of the law, coca leaves will generally be treated the same as any other illegal drug. 

Available medications for altitude sickness 

As well as all of the natural remedies for altitude sickness listed above, there is also prescribed medication available. It seems like travellers have long argued the effectiveness of this medication, with many arguing the meds themselves caused exactly the same symptoms as they were hoping to avoid. 

Doctors most commonly recommend acetazolamide to aid acclimatisation. It is often sold under the trade name of Diamox. This drug does not cure altitude sickness and merely hides the symptoms. As such, doctors will usually recommend that visitors to high altitude areas allow themselves an appropriate time to acclimatise rather than giving out pills. 

Quito is the world’s highest capital city.

It seems like the most common instance in which pills are recommended is when the traveller has not or cannot allow themselves the adequate time to acclimatise (like on a week-long holiday) or when they have flown directly into an area with high altitude.

As mentioned earlier, acetazolamide can have side effects. Generally, these reflect the symptoms that are caused by altitude sickness which means their utility is still a contentious issue which is debated amongst travellers.  

This post has been put together based on my experiences travelling around South America. As I have said previously, I am not a doctor. If you have concerns about adapting to altitude on your next trip, seek medical advice before you travel.

Have you ever experienced adverse effects from extreme change in altitude before?

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How to Prevent Altitude Sickness Naturally

04 Jan How to Prevent Altitude Sickness Naturally

Posted at 06:19h
in Stay Healthy
by Me & My Travel Bugs

If you plan on getting high (literally, I mean) on your next holiday, you’ll want some advice on how to prevent altitude sickness naturally. For sea level peeps like us, heading to the mountains means we need to think about the impact it might have on our health. And as anyone who’s had altitude sickness in the past can attest, it’s one that shouldn’t be ignored.

Because, without a doubt, the sites of Mexico City or the scenery of Machu Picchu and the Colorado Rockies just aren’t quite the same when you feel like rubbish. So let us share exactly what it is and some tips on how to prevent altitude sickness naturally on your next trip.


What is Altitude Sickness?


Altitude sickness is our body’s response to reduced oxygen and changes in air pressure that typically occur at altitudes above 8,000 ft (2,400 m). If you gain altitude too quickly, your body doesn’t have enough time to adjust. This causes what is known as hypobaric hypoxia – simply, a lack of oxygen reaching the tissues of your body.

In severe cases, fluid can build up in the lungs or brain. These more severe altitude conditions are known as high altitude pulmonary edema (HAPE) or cerebral edema (HACE). In most cases the body will adapt, it’s just a matter of time. These adaptations are increased respiratory ventilation, heart rate and blood flow to the brain, alkalising of the blood and increasing intimal smooth muscle the in arteries over several days.

If you move too high too quickly or your body can’t make these changes fast enough, you will suffer symptoms of altitude sickness.


Symptoms of Altitude Sickness


The symptoms of altitude sickness usually begin within six to 12 hours of arriving at altitudes above 8,000 ft (2,400 m). Often described as being similar to a hangover (a really bad hangover by the sounds of it) symptoms can include:
– headache
– fatigue / tiredness
– nausea / vomiting
– shortness of breath
– dizziness / feeling light-headed
– lack of appetite
– difficulty sleeping

These symptoms of altitude sickness are estimated to affect about 25% of people who live at a low altitude and sleep at an altitude above 8,000 ft (2,400 m). The number is closer to 50% once you reach 10,000 ft (3,000 m).

It’s also important to note that being young and fit does not reduce your risk and you could still experience symptoms of altitude sickness even if you haven’t been affected on previous climbs. I’ll also just point out that ladies seem to be less at risk than guys. No-one knows why but I think we can all agree it’s just another sign of our genetic advantage 😉

It’s also worth being aware of the more severe symptoms of high altitude pulmonary edema or cerebral edema (severe altitude sickness). If you experience any of these, forget the Gingko and get yourself straight to the emergency department, stat.
– breathlessness
– heart palpitations
– blue-tinged skin and nails due to lack of oxygen (cyanosis)
– frequent coughing because of fluid in the lungs
– sputum that is frothy or tinged pink with blood from damaged lung tissue
– inability to sit up or walk in a straight line.


How to Prevent Altitude Sickness Naturally


So I think we can all agree that no-one wants altitude sickness. My days of hangovers on holidays are well and truly over and I definitely don’t want fluid build-up in my brain or lungs… Lucky for you, we’ve done the research (most of it first-hand), so you can learn how to prevent altitude sickness naturally. Here’s what you need to do:


Take time to acclimatise.

If you read above about what altitude sickness is, you’ll understand why time is the most important factor in avoiding it. It is time that allows your body to adapt. This means you have to give yourself a few days to acclimatise.

If you are flying or driving directly to somewhere above 8,000 ft (2,400 m) (e.g. Cusco or La Paz) you’ll need to spend two or three days doing not much at all. This is even more important if you are traveling internationally on a long-haul flight and/or changing time zones. Your body needs time to get used to your new environment and sleeping patterns.

When we flew into Cusco (11,100 ft / 3,400 m) before hiking the Inca Trail in 2015, we arrived in the morning and spent the day relaxing in Cusco. The next day was spent mostly sitting on a bus at altitude and checking out the Sacred Valley. We then slept the night at Ollantaytambo near the start of the trail (9,200 ft / 2800 m) before beginning the hike the next morning. That gave us two full days before beginning any serious exercise and, on top of the other strategies listed below, we didn’t get any symptoms of altitude sickness at all.


Don’t rush it.

Once you start hiking above 8,000 ft (2,400 m) you need to take it slow. The altitude, not the pace, that is. A good rule of thumb is to ascend no more than 1,000 ft / 300 m per 24 hours. It’s also suggested that you spend an extra day acclimatising for every 3,300 ft / 1000 m you climb.

These rules are really important when it comes to sleeping at altitude. Which brings us to the next tip…


Climb high, sleep low.

The ‘climb high, sleep low’ philosophy is pretty simple. Even if you walk at altitudes above 300 m / 1,000 ft higher than the previous day, make sure you make your way down to the right altitude before sleeping.

Gentle walks to higher altitudes before descending to sleep are a common technique used on rest days during longer hikes – like the hike to Everest Base Camp. Which we never made, care of an earthquake in 2015… one day.


Stay hydrated.

Staying hydrated is another important tactic to prevent altitude sickness naturally. Drinking water is key (even if you do not feel thirsty) for a few reasons:
> Humidity is lower at higher altitude. This means sweat evaporates faster and can cause you to misjudge how much water you are losing through physical exertion (no sweat, no effort, right? Wrong).
> You lose more water through respiration at high altitudes. Because of the lower oxygen levels, you breathe faster and more deeply, causing you to lose up to twice as much water through respiration compared to at sea level.
> Altitude has a diuretic effect  i.e. it makes you pee. Your kidneys play an important role in the body’s adaptation to altitude and in the process can cause you to lose more water through urination.

And while you’re keeping your fluids up, here’s a few to avoid:
– Alcohol. It’s a depressant and can slow your breathing rate and cause dehydration.
– Caffeine. Caffeinated drinks, like coffee and energy drinks, can also lead to dehydration.

When it comes to staying hydrated at altitude, it’s recommended to drink an extra 1 to 1.5 litres of water per day to what you would at sea level. The best way to test if you’ve had enough water is to check your urine. If it’s dark rather than light or clear, you are dehydrated and need to drink more.


Eat. Mostly carbs.

What to eat at high altitude? Carbohydrates, is the simple answer. But you should keep it in balance, so make sure your main meals still contain some protein and healthy fats. But here’s a few reasons why skipping the Atkins diet at altitude is a good idea:
> Carbs require less oxygen for metabolism and digestion than fats and protein.
> At lower oxygen levels (e.g. at altitude) we use glucose (via glycolysis) for energy at a faster rate.
> Altitude affects our sense of taste, with most climbers preferring the taste of carbs rather than fats.

It’s also worth noting that altitude can trigger a lack of appetite, causing people to consume up to 40% less calories. So while you might lose your appetite at first, it’s vital to eat plenty of food, even if you are not hungry. After all, you burn more calories in cold, high altitude environments even at rest.

In terms of a rough macro split, we like to aim for 60-65% carbs, 20-25% protein and 15-20% fats when at altitude.


Breathe Deeply.

For the yogis, this means practising pranayama. Slow deep breathing at high altitude has been shown to increase blood-oxygen levels and ventilation efficiency. To get the best effect, breathe in and out through your nose and take slow and long deep breaths until your stomach expands. The trick is to do this without breathing too slow and creating stress or tension.


Use Ginkgo Biloba.

If you’re looking for an extra boost to prevent altitude sickness naturally but don’t like the idea of drugs or side effects, Ginkgo Biloba is for you. This natural supplement is a herbal extract from the leaves of the Ginkgo tree and has been used for thousands of years to treat a range of illnesses.

It has been scientifically studied for its beneficial effects on altitude sickness, with great success. This study and this study are both good examples. While some websites will say the evidence is inconclusive, it’s important to remember that the source and composition (read: quality) of the Ginkgo is important to it’s effectiveness for altitude sickness prevention. So go with a quality recommended brand, not the cheapest version you can find online.

It’s best to start taking the Ginkgo Biloba 4 – 5 days before reaching altitude and for the duration of your time at altitude. The recommended dose is 80 – 120 mg twice a day, morning and evening. Because it works by thinning the blood and increasing circulation, there are some contraindications for people on medicines that do similar things. As always, it’s best to check with your health practitioner during a pre-travel health consult.


Chew Coca leaves with the locals.

As is often the case, the locals know best. And if you are traveling to Central or South America for a hike, you may wish to get on board with the local custom of chewing coca leaves. Be aware though that even one cup of coca tea can result in a positive cocaine drug test, apparently. So it’s best avoided by professional athletes and anyone who might be subjected to a drug test for work.

But for the rest of us, you can either chew the leaves or make tea. Perfect for cold mornings in the Andes. Yes, it’s 100% natural and coca has been shown scientifically to induce biochemical changes that enhance physical performance at high altitudes, including on treks to Everest Base Camp.


What about Altitude Sickness Medication Alternatives?


Many travelers to high altitude will be prescribed the drug acetazolamide (Diamox) by their local doctor because of its ability to improve oxygenation of the blood. Unfortunately, as with most drugs, it comes with a list of common side-effects.

These side-effects include nausea, diarrhea, fatigue, frequent urination and fever. Which sound a lot like the kind of symptoms you’re trying to avoid on a multi-day hike. We were fortunate to have learnt how to prevent altitude sickness naturally before our first high mountain trek and so have never taken it ourselves. But we’ve been on hikes with people who have and the outcome wasn’t pretty for quite a few of them.

There is another drug, dexamethasone (Ozurdex), which has also been used to prevent altitude sickness, but with mixed results and its own list of side-effects that include ulcers, cataracts and depression. No thanks.


Altitude Sickness Treatment


Prevention is obviously the best treatment. Once you’ve got altitude sickness, most of the methods here won’t do a good job at improving symptoms. While you should still follow the same tips, the best thing you can do is to descend.

Depending on the severity of symptoms, most people find that with an extra day or two at the same altitude, their body has time to adapt and they can resume activities. For anyone who experiences altitude sickness, wait up to 12 hours for symptom improvement at the same altitude. If symptoms don’t improve, descend at least 1,000 ft (300 m) and reassess your symptoms after 12 hours.

If you’re not able to descend because of symptoms or weather, treat with oxygen if available. Some places will also have portable hyperbaric chambers at rescue stations or carried by rescue workers that should lead to pretty rapid symptom improvement.

Learn how to prevent altitude sickness naturally and you’ll be crushing mountains with ease!

Healthy Travel Tips – How to Prevent Altitude Sickness Naturally


1. Take time to acclimatise when traveling to regions above 8,000 ft (2,400 m).
2. Ascend no more than 1,000 ft / 300 m per 24 hour period.
3. Sleep at a lower altitude than you climbed that day.
4. Stay hydrated and drink an extra 1 – 1.5 L of water per day.
5. Aim for 60% of your calories to come from healthy sources of carbohydrates when at altitude.
6. Focus on slow and deep breathing.
7. Take Ginkgo Biloba, starting 4-5 days before you reach altitude and continue for the duration of your hike. The recommended dose is 80 – 120 mg twice a day.
8. When visiting central and south America, chew coca leaves to help with symptoms of altitude sickness.

Do you have any of your own tips on how to prevent altitude sickness naturally? Let us know in the comments.

Altitude sickness – NHS – NHS

You can get altitude sickness if you travel to a high altitude too quickly.

Breathing becomes difficult because you’re not able to take in as much oxygen.

Altitude sickness, also called acute mountain sickness (AMS), can become a medical emergency if ignored.

Your age, sex or physical fitness do not affect your likelihood of getting altitude sickness.

Also, just because you may not have had it before, this does not mean you will not get it on another trip.

Symptoms of altitude sickness

Symptoms of altitude sickness usually develop between 6 and 24 hours after reaching altitudes more than 2,500m above sea level.

Symptoms are similar to those of a bad hangover and include:

  • headache
  • feeling and being sick
  • dizziness
  • tiredness
  • loss of appetite
  • shortness of breath

The symptoms are usually worse at night.

Altitude sickness does not only affect mountain climbers. Tourists travelling to cities that are 2,500m above sea level or higher, such as La Paz in Bolivia or Bogotá in Colombia, can also get altitude sickness.

It’s not possible to get altitude sickness in the UK because the highest mountain, Ben Nevis in Scotland, is only 1,345m.

Preventing altitude sickness

The best way to prevent getting altitude sickness is to travel to altitudes above 2,500m slowly.

It usually takes a few days for your body to get used to a change in altitude.

You should also:

  • avoid flying directly to areas of high altitude, if possible
  • take 2 to 3 days to get used to high altitudes before going above 2,500m
  • avoid climbing more than 300m to 500m a day
  • have a rest day every 600m to 900m you go up, or rest every 3 to 4 days
  • make sure you’re drinking enough water
  • avoid smoking and alcohol
  • avoid strenuous exercise for the first 24 hours
  • eat a light but high-calorie diet


Consider travelling with these medicines for altitude sickness:

In the UK, acetazolamide is not licensed to treat altitude sickness. But it’s available from most travel clinics and some GPs may prescribe it.

Promethazine is available from pharmacies. You do not need a prescription to buy it.

Begin taking acetazolamide 1 to 2 days before you start to go up in altitude and continue to take it while going up.

You should still go up gradually and follow the prevention advice, including taking time to acclimatise, having regular rest days and drinking plenty of water.

If you get symptoms of altitude sickness while taking acetazolamide, rest or go down until you feel better before going up again.

Treating altitude sickness

If you think you have altitude sickness:

  • stop and rest where you are
  • do not go any higher for at least 24 to 48 hours
  • if you have a headache, take ibuprofen or paracetamol
  • if you feel sick, take an anti-sickness medicine, such as promethazine
  • make sure you’re drinking enough water
  • do not smoke, drink alcohol, or exercise

Acetazolamide can be used to reduce the severity of your symptoms, but it will not completely get rid of them.

Tell your travel companions how you feel, even if your symptoms are mild – there’s a danger your judgement may not be clear.

You can continue going up with care once you feel you have fully recovered.

If you do not feel any better after 24 hours, go down by at least 500m (about 1,600 feet).

Do not attempt to climb again until your symptoms have completely disappeared.

After 2 to 3 days, your body should have adjusted to the altitude and your symptoms should disappear.

See a doctor if your symptoms do not improve or get worse.


If the symptoms of altitude sickness are ignored, they can lead to life-threatening conditions affecting the brain or lungs.

High altitude cerebral oedema (HACE)

High altitude cerebral oedema (HACE) is swelling of the brain caused by a lack of oxygen.

Symptoms of HACE include:

  • headache
  • weakness
  • feeling and being sick
  • loss of coordination
  • feeling confused
  • hallucinations (seeing and hearing things that are not there)

A person with HACE will often not realise they’re ill. They may insist they’re OK and want to be left alone.

HACE can develop quickly over a few hours. It can be fatal if it’s not treated immediately.

Treating HACE:

  • move down to a lower altitude immediately
  • take dexamethasone
  • give bottled oxygen, if available

Dexamethasone is a steroid medicine that reduces swelling of the brain. It’s often carried by professional mountain climbers as part of their medical supplies.

If you cannot go down immediately, dexamethasone can help relieve symptoms until it’s safe to do so.

You should go to hospital as soon as possible for follow-up treatment.

High altitude pulmonary oedema (HAPE)

High altitude pulmonary oedema (HAPE) is a build-up of fluid in the lungs.

Symptoms of HAPE:

  • blue tinge to the skin or lips (cyanosis)
  • breathing difficulties, even when resting
  • tightness in the chest
  • a persistent cough, bringing up pink or white frothy liquid (sputum)
  • tiredness and weakness

The symptoms of HAPE can start to appear a few days after arrival at high altitude. It can be fatal if it’s not treated immediately.

Treating HAPE:

  • move down to a lower altitude immediately
  • take nifedipine
  • give bottled oxygen, if available

Nifedipine is a medicine that helps to reduce chest tightness and make breathing easier. It’s also often part of an expedition’s medical supplies

You should go to hospital as soon as possible for follow-up treatment.

If you’ve had HAPE, you can register with the International HAPE Database to help develop new treatments for the condition.

Page last reviewed: 13 March 2020
Next review due: 13 March 2023

Avoiding Altitude Sickness: Complete Beginner’s Guide (2021)

This is the beginners guide to avoiding altitude sickness in 2021.

View of Mount Everest from Rongbuk Monastery on the Tibet side. ©YoWangdu

In this comprehensive guide, you will learn:

  • Three simple rules that could save your life
  • Myths about altitude sickness
  • High altitude dos and don’ts
  • Lots of practical tips to use right now

If you want to learn how to prevent altitude sickness and stay healthy on your travels at high altitude — from Tibet to Kilimanjaro to Colorado — you’ll love this guide.

Let’s get started.

Chapter 1: Altitude Sickness Basics

In this chapter we’ll give you the fundamentals of altitude sickness.

Through personal experience and research, we’ve learned how to feel MUCH better at high altitude on trips to Tibet. 

We’ll share with you the lessons we’ve learned along the way.

So you won’t need to repeat our mistakes, no matter where you are traveling.

It is important to note that we are not medical experts and all the information provided here is only for educational purposes and not to be taken as professional advice. For your safety, consult with your doctor before undertaking any course of action related to altitude sickness medication or treatment!

What is altitude sickness?

Altitude sickness is your body’s negative reaction to traveling too quickly to high altitudes. As you go higher — especially to locations over 8000 ft like Lhasa, Cuzco, Telluride, or the peak of Kilimanjaro  — the air becomes “thinner.” 

That means, because of the lower air pressure at higher elevations, there is less oxygen available in each breath you take.1 

Right away, your body begins to work to make the best use of the reduced oxygen available. 

It physically changes, in some fascinating ways, to begin to adapt to the lack of sufficient oxygen.

The Bernese Alps: A view from Murren, Switzerland. ©YoWangdu

What is a normal reaction to high altitude?

In the first few days, you will breathe faster and deeper, to take in more oxygen, and your heart rate will increase. 

Your body will be going through a number of complex changes. 

To put the science as simply as possible:

Due to breathing faster and deeper, your body takes in more oxygen but loses carbon dioxide. The blood becomes abnormally alkaline.

The body now has to figure out how to restore its normal acid-base balance.

One way it does this is by suppressing breathing! This becomes especially apparent at night. (More on that later…)

Another way is by reducing alkalinity through urine. 2 

For an excellent breakdown of the many complex changes that happen in the first few days of normal acclimatization, see Inga Aksamit’s An Unofficial Acclimatization Guideline for JMT Hikers.

The bottom line?

Your body will be going through some significant changes when exposed to high altitude, and you will need to give it some time to sync up all the processes. 

Most of these changes happen in the first two days at higher altitudes, though for some people, it can take four days. 

During this time, you may very likely:

  • Notice a feeling of breathlessness when you exert yourself at high altitude. 
  • Experience a changed breathing pattern at night, called periodic breathing. In periodic breathing (also called PB or Cheyne Stokes breathing), the breath alternates between deep and shallow breathing. As a result, you may wake frequently and feel a lack of air. 
  • Need to urinate more frequently. 
  • Become dehydrated, as your urine output increases, and as you lose more fluids due to your increased breathing rate and the dry mountain air. (Note that if you exert yourself physically while acclimatizing and therefore perspire more, you will intensify the tendency to dehydration.)

The changes you experience may not feel great, but they are normal acclimatization. They don’t mean that you have altitude sickness. 

If you do not go higher, stay sufficiently hydrated, and do not physically overexert yourself, most people will slowly begin to feel more normal after 1-3 days. 

Everyone will experience the normal physiological changes at altitude. And many will experience the sometimes unpleasant effects of these changes.

But not everyone gets sick.

How to know when you have altitude sickness and not just a normal reaction to high altitude?

View on the Duck Lake Trail in the Mammoth Lakes area of California. ©YoWangdu

The first and mildest form of altitude sickness is called Acute Mountain Sickness (AMS).

AMS can develop anytime in the first 24 hours or so at sleeping altitudes above 6000 ft. Though it is uncommon to develop AMS below 8000 ft, it can affect some particularly sensitive individuals at lower altitudes.

The classic first symptom is a headache. 

When you have a headache plus any one of the following — nausea, dizziness, fatigue, loss of appetite, vomiting, weakness  — then you can assume you have AMS.

A lot of people compare the mild stages of altitude sickness to having the flu, or a hangover. Some people feel truly horrible, and some just feel sort of crappy. 

So what’s the big deal about getting AMS? And why should you not just power on if you have the symptoms?

Why you absolutely should not ignore mild altitude sickness

Developing the early stages of altitude sickness is a warning sign that you are not acclimatizing well. And you may be at a higher risk of two much more dangerous conditions: 

One is called HACE and harms your brain. 

The other is HAPE and harms your lungs.

Both are potentially fatal, and if unrecognized and untreated can kill you within a matter of hours. 

We don’t say this to scare you, but because we want you to know that AMS, if ignored, can lead to HACE. And that the conditions that produce AMS also can produce HAPE. 

Wilderness medicine expert Tod Schimelpfenig has reminded us that to be clear, you can get HAPE, and possibly HACE, without symptoms of AMS. However, it’s good to know that AMS is a heads up that your body is not acclimatizing normally and you need, at the very least, more time to adjust to altitude.

People who get seriously ill and die from altitude sickness almost always ignored the earlier, milder warning signs. 

No one needs to die from altitude sickness, and this guide is all about giving you simple tools to keep you on the safe and happy side!

Let’s start with a basic fact…

Individual responses to altitude vary a lot

It’s important to know that individual bodies can respond to high altitude quite differently.

Some people are naturally less susceptible to developing altitude sickness.

Those who do develop AMS, do so at varying altitudes. Some develop symptoms at 6,000 feet. Others can go thousands of feet higher before feeling anything. 

Therefore, remember that any stories you hear of strategies that work for one person tell you nothing about how you may react to altitude. 

It is REALLY important to understand this.

You and your friends or family may react completely differently at high altitude.

Yolanda and Lobsang, the authors of this article, have helped hundreds of people travel to Tibet, and we have heard so many different stories of how travelers have felt on arrival at the Tibetan Plateau.

View of Ganden Monastery and the Kyichu River Valley in Tibet from the Wangpo Ri. ©YoWangdu

Some people say that they feel absolutely fine. Others feel like they have a bad flu.

We ourselves have had very different experiences on different trips.

The bottom line is that you can’t rely on another person’s experience to tell you what might happen with your body at high altitude.

Here’s one important thing you should know…

The surprising truth of who is at risk of getting altitude sickness

Your risk of getting altitude sickness has nothing to do with your age or physical fitness. 

A 20-year old fitness-freak marathon runner has no less risk than a 60-year old couch potato.

That’s right. 

In fact, there is some anecdotal evidence that younger, fitter travelers may actually be at greater risk because of a tendency to think they can or should power through the initial symptoms.

The percentage of people who develop altitude sickness symptoms at high altitude is not known exactly, but here are some statistics of the percentage of travelers experiencing symptoms of altitude sickness:

  • 43% of trekkers at Pheriche, Nepal (14,248 ft/ 4343 m)3
  • 36.7% of tourists in Lhasa, Tibet (11,975 ft/ 3658 m ) 4
  • 53% of trekkers at Pheriche, Nepal (a different study) 5

The major risk factors for altitude sickness are:

  • Your rate of ascent to high altitude
  • A prior history of altitude sickness
  • Your genetic makeup

You have no control over your genes, but to avoid getting altitude sickness, you need to make a slow ascent a priority. Especially if you have previously experienced altitude sickness in the mountains. (More on that in Chapter 4.) 

But first, here’s a quick personal story of how we learned to feel MUCH better at high altitude on our trips to Tibet by following the basic rules we will share with you in this guide. 

A personal lesson learned about how to feel MUCH better at altitude 

Our own first experience with travel to high altitude in Tibet is a cautionary tale of exactly what NOT to do…

Trip One: Fast Ascent, No Meds, Feeling Wretched

On our joint first trip to Tibet, we (your authors, Yolanda and Lobsang)  knew nothing and we did everything that we should not do. Here’s a list of some of our mistakes:

  • We flew from 1500 ft in Chengdu to Lhasa (~12,000 ft)
  • We did not take altitude sickness medication
  • Before we were fully acclimatized to Lhasa, we took a trip to Lake Namtso, which is 3500 ft higher. 

Generally speaking, we felt like hell for 2-3 days in Lhasa. Like we had a gnarly hangover or a mild flu. We slept horribly, had solid headaches all the time, mild nausea, and weakness. After we felt a bit better, we took off on a road trip to even higher altitude and slept at Lake Namtso, where we repeated feeling and sleeping crappy, for just one night, thankfully.

The ONLY thing we did right was that we rested, almost completely, those first 2-3 days in Lhasa. It’s when travelers don’t rest and insist on hiking or skiing when they have the first symptoms of altitude sickness, that they are at greatest risk of developing HACE or HAPE.

Trip Four: Slow Ascent, Meds, Feeling Great

Three trips to Tibet later, Yolanda had her systems down. With her friend Meg, she: 

  • Flew to an intermediate elevation, the city of Xining, at 7500 ft, and slept there for two nights to begin to acclimatize.
  • Chose to take a train rather than a flight for the remaining distance to Lhasa.
  • Took acetazolamide (Diamox), altitude sickness medication, starting 24 hours before reaching high altitude 
  • Did not plan any major activities the first days in Lhasa.
  • Allowed 4-5 days in Lhasa before continuing the journey.
  • On a road trip out of Lhasa, planned the journey in steps, to increase the sleeping elevation each night gradually.

The difference in how Yolanda felt from this trip and the last one was HUGE. At every step along the way, she and Meg felt good. There were no wasted days of laying around feeling sick. And even though we took it easy in Lhasa the first few days, we had a great time walking casually around.

You might be wondering:

What do I need to know and to do to feel healthy when I go to Lhasa, or Telluride, or Everest or Kilimanjaro? 

That’s what we’re going to cover in the rest of this guide.

But first, some simple rules from altitude experts… 

Yolanda O’Bannon and Meg Moser on the long way down from the Chitu La pass near Samye, Tibet. (16,732 ft/ 5100 m) .

Chapter 2: Simple Rules that Could Save Your Life

If you remember nothing else from this post, let these rules be your guide when you go to high mountains.

The Golden Rules of Avoiding Altitude Sickness

  1. If you feel unwell at altitude it is altitude illness until proven otherwise. 
  2. Never ascend with symptoms of AMS.
  3. If you are getting worse (or have HACE or HAPE), go down at once. 

— Originated by Dr. David Shlim at the CIWEC Clinic, Kathmandu

U.S. CDC Recommendations to Prevent Death or Severe Illness at Altitude

  • Know the early symptoms of altitude illness, and be willing to acknowledge when they are present.
  • Never ascend to sleep at a higher altitude when experiencing symptoms of altitude illness, no matter how minor they seem.
  • Descend if the symptoms become worse while resting at the same altitude.

— United States’ Center for Disease Control Rules for Altitude:

How exactly can you know the early symptoms?

Read on…

Chapter 3: What Does Altitude Sickness Feel Like?

Now it’s time to get into the nitty gritty of high altitude sickness. 

Specifically, we are going to look at the symptoms of the three types of altitude sickness.

And in this chapter we are going to show you the warning signs to look for, in yourself and your companions.

Let’s dive right in.

How to recognize the early symptoms of altitude sickness

The first symptoms of altitude sickness usually begin 2-24 hours after you arrive at altitudes over 8000 ft/2500 m. (Particularly after the first night at a new altitude.)

(Though some people get altitude sickness as low as 6500 feet/2000 meters, it’s more common for those who are susceptible to start developing symptoms over 8000 ft.)

Again, the hallmark symptom is headache, though if you have a headache alone, this is not considered altitude sickness. Also, some people will have AMS without a headache, but with the other symptoms.

If you have a headache along with any of the following, you can assume you do have Acute Mountain Sickness (AMS):

  • tiredness/weakness/fatigue
  • light headedness or dizziness
  • vomiting/nausea
  • shortness of breath
  • loss of appetite
  • A general feeling of malaise

Generally speaking, you may feel like you have the flu, or an alcohol hangover. 

Nauseous and headachy after a sleepless night with mild altitude sickness at Lake Namtso in Tibet (15,479 ft.)

Having AMS in itself is not life-threatening. 

However, it is not “normal” to have a headache at altitude. If you do, you need to be willing to admit that you may have altitude sickness, and to respond with the appropriate actions. This is the first, critical, step to stay out of trouble.

While you are experiencing symptoms of altitude sickness, the most critical thing you should do is NOT GO ANY HIGHER. 

AMS symptoms normally begin to decrease after about three days, but in some rare cases, they progress to a more severe form of high altitude sickness. 

This is why it is important to look out for the development of further symptoms that might lead to High Altitude Cerebral Edema (HACE).

You’ll learn the signs and symptoms of HACE right now…

How to know when your brain is in trouble

“Cerebral,” of course, refers to the main part of your brain, the cerebrum. And “edema” is swelling caused by excess fluid in your tissues. 

When you have HACE, your brain swells, and stops functioning correctly. 

This is why victims of HACE display:

  • Loss of physical coordination
  • Act confused or disoriented
  • May have a change of personality and may display, for example, uncharacteristic euphoria or depression
  • May have slurred speech/garbled speech, or a loss of speech

They may appear drunk. And If the victim gets worse, he or she may exhibit:

  • Hallucinations
  • Drowsiness / semi-consciousness
  • Coma

You should note that a person with HACE is confused and unable to think clearly. 

He or she will likely not understand that they are in danger. 

Also, as they lose physical coordination, they are at greater risk of falling.

HACE can be fatal within 48 hours or less if untreated. 

Warning Signs of HACE

The warning signs to look for, especially if the person has shown symptoms of AMS:

  • Loss of coordination, which may manifest as an unsteady walk, or a staggering walk as if the person is drunk. To test the victim, have the person walk a straight line. Draw a straight line on the ground, and ask the victim to walk the line, with one foot in front of the other, heel to toe. If she or he cannot do this quite easily, you can assume the person has HACE.
  • Disorientation or confusion

Other signs and symptoms that are not specific to HACE but that suggest AMS and may be part of the picture:

  • Splitting headache that is not helped by medication (Note that you can have HACE without a headache, as well.)
  • Nausea and vomiting (or an increase in nausea and vomiting)
  • Increasing fatigue and weakness, and decreasing activity (The victim appears excessively tired, and is dragging behind everyone else.)
  • Sleepiness
  • Shortness of breath

HACE can be misdiagnosed as hypothermia, diabetes, or the consumption of excess alcohol or recreational drugs.  (Alternatively, one of these problems can be misdiagnosed as HACE.)

Before talking about the important topic of treatment of HACE, let’s look at another potentially fatal form of altitude sickness called HAPE.

How to know when your lungs are in trouble

High Altitude Pulmonary Edema, or HAPE, causes a dangerous accumulation of fluid in your lungs. 

Unlike HACE, it is not a more extreme form of AMS. Although people with HAPE also often have AMS, it is possible to have HAPE without any signs or symptoms of AMS.

A person with HAPE will have:

At least two of the following symptoms:

  • Cough
  • Difficulty breathing when at rest
  • Chest tightness or congestion
  • Weakness or decreased exercise performance

At least two of the following signs:

  • Wheezing or crackles in at least one lung field
  • Central cyanosis (Purple or bluish discoloration of the tongue, lips, and mouth, which is often accompanied with peripheral cyanosis, a blueness visible in the fingernail beds.)
  • Tachycardia (abnormally fast heart rate)
  • Tachypnea (abnormally fast breathing)

—According to the Lake Louis Consensus on the Definition of Altitude Sickness

Warning Signs of HAPE

Look for:

  • Increasing breathlessness on exertion leading to shortness of breath even at rest 
  • Cough, which possibly produces pink or frothy sputum 
  • Extreme fatigue 
  • Sounds of gurgling, rattling, wheezing, or crackling when breathing
  • Fast, shallow breathing 
  • Feelings of fullness, tightness, or congestion in the chest
  • Gray, blue or purple lips or fingernails. 
  • Drowsiness

HAPE often occurs 2-5 days after an ascent. 6

Importantly, HAPE can be confused with other respiratory conditions, like a high altitude cough, bronchitis, asthma, or pneumonia. 

HAPE can be fatal if untreated, and is the leading cause of death due to altitude sickness.  Like HACE, it can progress rapidly. 

That’s the bad news. 

The good news is that both HAPE and HACE can be preventable. 

The great majority of people who get HACE ignored the rule against descending to a lower elevation with symptoms of AMS. 

Similarly, the great majority of victims of both HACE and HAPE ignored the primary rules of altitude sickness prevention. 

With that, here’s how to avoid getting altitude sickness…

Cross-country ski trail at Lake Tahoe, California.

Chapter 4: How to Avoid Altitude Sickness

For the best chance to avoid getting sick or dying from altitude sickness, you need to take one simple step. 

Here it is:

#1: Ascend slowly

Your most effective way to prevent altitude sickness is incredibly simple. 

Ascend slowly.

It doesn’t matter how you ascend — flying, driving, hiking or climbing. If you increase your elevation too quickly, you are at high risk of getting sick.

AMS [Acute Mountain Sickness] is…highly correlated with speed of ascent…

— The incidence, importance, and prophylaxis of acute mountain sickness

There is no 100% sure way to avoid getting altitude sickness because each individual has a unique response to high altitude based on your physiology and genetics. 

HOWEVER, the great majority of us can reduce the risk of getting sick at high altitude by just giving our bodies time to adjust to the decreased oxygen. 

You can do this by taking your time to get to sleeping altitudes above 8000 ft/~2500 m. 

That means sleeping at intermediate elevations on the way up, to give your body time to acclimatize.

It’s how high you sleep that counts!

Have you ever heard the mountain climber’s mantra of “Climb high, sleep low?” 

In terms of getting altitude sickness, the altitude that you sleep at is more important than how high you go during the day. 

This is because sleeping at higher altitudes deprives your body of sufficient oxygen more than a day trip does. 


As Dr. Roger Thompson notes on the APEX website: “During sleep at high altitude, the levels of carbon dioxide in the blood can drop very low and this can switch off the drive to breathe.”

As NOLS Wilderness Medicine Curriculum Director Tod Schimelpfenig7 notes, the point here is that we breathe better when awake and moving than when sleeping so we become more hypoxic at night. (Hypoxia is a condition in which the body’s tissues are deprived of an adequate oxygen supply.)

So you need to pay attention to the elevation at which you sleep and not as much to elevations you may climb to or visit during the day.

So how do I ascend slowly enough to stay healthy?

The general rules of thumb for ascending for the purpose of avoiding altitude sickness are:

  • Allow at least two days to reach 9000 ft/~2700 m.  
    • Plan to spend at least a night somewhere between ~6500 ft/ 2000 m and 9000 ft/~2700 m. 
    • Note that there is some evidence that sleeping at an elevation of 9,000 feet is more effective than lower elevations. 
  • After you reach 9000 ft/ 2700 m, do not increase your sleeping altitude more than ~ 1500 ft/ 500 m per night.
  • Spend an extra night at the same elevation every ~3000 ft/ ~1000 m. This means  that you would spend an extra night at the same elevation every 3 to 4 days.

#2: If you can’t ascend slowly, consult a doctor for Diamox

The absolute best way to prevent altitude sickness is to ascend slowly, but if that is not possible, you should consider asking a doctor about getting a prescription for Diamox, a medication used to prevent altitude sickness.

Diamox is the only altitude sickness medication that has been proven in peer-reviewed clinical trials to effectively prevent altitude sickness and help your body speed up the acclimatization process. (Unless you go too high, too fast.)

View of the mountains from a flight leaving Lhasa in mid-winter. ©YoWangdu

How Diamox works in your body

You may remember that as the body acclimates to high altitude, your blood becomes overly alkalinic. This imbalance in turn causes a problem for the body – suppressed breathing. 

Diamox enhances the body’s efforts to reduce alkalinity in the blood.

As the CIWEC Hospital notes, in Altitude Illness Advice for Trekkers, “Diamox blocks an enzyme in the kidney and makes the blood acidic which is interpreted by the brain as a signal to breathe more.”

Notes for taking Diamox
  • The recommended dose for prevention for an adult is 125mg every twelve hours. Higher doses have been shown to be effective, but produce more frequent and/or worse side effects. Lower doses (62.5mg every twelve hours) have also been found effective in a small study, but are not yet recommended as further research is needed. 8
  • Acetazolamide is typically taken starting 24 hours before you begin ascending to high elevations, and stopping either after reaching a high point and having begun descent, or, in the case when ascending to one elevation and remaining there, after 2-3 days at the high altitude.
  • If you are severely allergic to sulfa drugs, you may be at risk for cross-sensitivity. Talk to your doctor about strategies for determining if you are allergic, or for alternatives. But note that but most people allergic to a sulfa antibiotic are not allergic to acetazolamide. A trial of Diamox under a doctor’s supervision should be done if there is a sulfa allergy history. Such trials often show it is ok to take Diamox.
  • Note that Diamox can be used for both prevention and treatment of altitude sickness, though higher doses are used for treatment.

There are a number of myths about Diamox that we explore in the Myths section below.

Other prescription medicines for altitude sickness

There are a handful of other prescription medicines that are also used for altitude sickness prevention. 

These medications have more specialized uses and should be discussed with your doctor. 

  • Dexamethasone: For prevention of AMS for those who may have an allergic reaction to acetazolamide. Dexamethasone does not speed acclimatization but can be used to treat symptoms. It may be used for treatment of AMS. 
  • Nifedipine: For prevention of HAPE in people particularly susceptible to it.

If you are going to very high remote places, you might want to talk to your doctor about getting prescriptions for medications that treat HACE and/or HAPE. 

Some of the medications we listed are also used as treatment for existing altitude sickness, but we will not discuss that here as we are only focusing on prevention in this post. 

(For more about medications used for treatment of altitude sickness, see the “Medications” section of the US CDC page on altitude sickness.) 

What about Ibuprofen?

There has been a lot in the media on the effectiveness of ibuprofen for preventing altitude sickness. 

However, a major study by top altitude sickness experts published in February 2019 concluded that “ibuprofen was slightly inferior to acetazolamide for acute mountain sickness and should not be recommended over acetazolamide for rapid ascent.” 9  

Still, Dr. Peter Hackett, one of the authors of the 2019 study, has also noted that “it is non-prescription, safe and most folks know how to use it, and it is only slightly inferior to Diamox.” 10

The widely respected Wilderness Medical Society also prefers acetazolamide and dexamethasone to ibuprofen. They cite the above and other studies, and note that ibuprofen’s “efficacy and safety (eg, the risk of gastrointestinal bleeding or renal dysfunction) over longer periods of use at high altitude remain unclear.” 11 

What about natural remedies?

There are a number of homeopathic or herbal remedies that are popularly considered to be helpful for altitude sickness.

However, none of them have been clinically proven to effectively prevent altitude sickness. 

Some of them have shown promise in a few studies, but to date there is no reliable clinical evidence to support the use of:

  • Coca leaves
  • Gingko biloba
  • Rhodiola
  • Chinese herbals medicines such as Sheng nao kang pills,  Fufang yi hao pills, Shu li kang capsules, Xing nao jing injections, and Danhong injection. 

Although natural remedies are attractive to many travelers, we do not recommend them until more robust clinical data is available. 

If you don’t want to use Diamox, the preferred prevention tool would then be a slow ascent. 

Coca leaves

A good example of a popular natural remedy is coca leaves. Note this discussion in the preeminent Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness.

“Chewed coca leaves, coca tea, and other coca-derived products are commonly recommended for travelers in the Andes for prophylaxis, and anecdotal reports suggest they are now being used by trekkers in Asia and Africa for similar purposes. However, their utility in prevention of altitude illness has never been systematically studied, and they should not be substituted for other established preventive measures….”

Note: It has been reported that coca leaves may be drug testable as positive for cocaine.

Gingko Biloba

Another supplement is Ginkgo Biloba, which is popularly thought to be helpful in avoiding altitude sickness. 

However, the Wilderness Medical Society guidelines, notes that:

“Although several trials have demonstrated a benefit of Ginkgo in AMS prevention, several negative trials have also been published. This discrepancy may result from differences in the source and composition of the Ginkgo products. Acetazolamide is considered far superior prophylaxis for AMS prevention.” 

Chinese herbal medicines

Chinese herbal medicines are similarly untested. 

An evidence-based study, Chinese Herbal Medicine for Acute Mountain Sickness: A Systematic Review of Randomized Controlled Trials,  determined that: 

“No firm conclusion on the effectiveness and safety of Chinese herbal medicine for AMS can be made. More rigorous high-quality trials are required to generate a high level of evidence and to confirm the results.”

Given travelers’ high interest in more natural altitude sickness medicines, we hope that more studies will be undertaken to help provide evidence-based guidance. 

Until then, Diamox is considered the medicine of choice if you absolutely cannot ascend slowly.

We hope that it is clear to you that prevention is the best cure for altitude sickness. 

Still, it’s good to know the basic treatments if you or a companion does get sick.

Chapter 5: Treatment

At the highest point on the Kailash trek — the 18,500 ft Dolma La Pass — a young Chinese woman, in blue, bent over, in trouble from altitude sickness.

As much as we urge you to take all the preventive steps, no guide to altitude sickness would be complete without a chapter on treatment. 

Here are the basics:

What to do if you have symptoms of Acute Mountain Sickness

Above all, it is important to take AMS seriously, even if “all” you’re feeling is a headache and a little nausea, for example. 

Even if you have just headache and one other AMS symptom, you can assume you have mild Acute Mountain Sickness. 

And what you do next will either keep you out of trouble, or put you at risk of developing much more serious symptoms.

You should:
  • If your symptoms are mild, stay at the same elevation until your symptoms resolve. 
  • Let your travel companions and guide know about your symptoms
  • Watch yourself and others for early warning signs that the AMS has progressed, or for HACE or HAPE.
  • If your symptoms are severe or worsen rapidly, descend to a lower elevation immediately.  
  • You can also treat your headache with ibuprofen or acetaminophen, and your nausea with nausea medication such as ondansetron12.
If available consider:
  • Use supplemental oxygen (at a rate of 2 litres a minute and/or until oxygen saturation levels are above ~90%).
  • Diamox, the prescription medicine used to prevent AMS, can also be used for treatment of AMS. (The US CDC article on High-Altitude Travel & Altitude Illness  recommends 250mg twice a day.) It is important to discuss this with your medical professional prior to your trip.

It sounds simple but you’d be surprised how many travelers develop mild AMS, and continue to ascend higher. 

One big issue is the desire to stay with one’s group.

Often, the sick person’s tour group is continuing on to the next town, which is at a higher elevation. 

Or, a traveler feels awkward about calling attention to their condition if the symptoms seem so mild. 

For whatever reason, travelers do it all the time.

By climbing or driving or flying higher with AMS symptoms, you put yourself  in considerable danger. 

As much as you may be reluctant to disrupt your group, you may end up making things worse for them if they have a seriously ill person to rescue vs. making routine arrangements for you to stay behind for a day or descend. 

It is not common for mild AMS symptoms to progress to life-threatening, but the great majority of people who develop High Altitude Cerebral Edema (HACE) ignored the rule against ascending with symptoms of AMS.

Once you have identified AMS in yourself or someone else, it is important to watch for the development of worsening symptoms, in which case you should descend without delay. 

It is especially important to look out for brain-related signs of symptoms of HACE.

What to do if someone has symptoms of HACE

If someone in your group shows any signs of confusion or a lack of physical coordination (or any of the other HACE symptoms, you must take immediate action.

Get the person to a lower elevation, ideally at least 2,000 – 4,000 ft / ~ 600 – 1,200 m. Even a few hundred ft (~ 100 m) may help. 

Don’t leave it until the victim’s condition worsens to the point to which she or he cannot walk at all. 

One issue with HACE is that it often happens, or at least begins, at night. 

This can be a real problem.

 If the traveler’s thought processes are negatively impacted by HACE in the night, she very well may not understand that she is in trouble. The problem may not be noticed until a companion notices odd behavior. 

Even if the problem is noticed right away, there are normally complications with descending to a lower altitude in the middle of the night.

And though it may be very challenging to deal with the situation, you can’t wait until morning since delay can be fatal. 

It is recommended to go down to the last point at which the traveler woke up feeling well, without symptoms of AMS. 

Additional Options:
  • Oxygen
  • The prescription medicine dexamethasone can be prescribed by a doctor for the emergency treatment of HACE in remote high altitude situations — but this is beyond the scope of this article written for beginners. 13
  • Hyperbaric bags are used by mountaineering expeditions and mountain clinics to treat HACE. 14

What to do if someone has symptoms of HAPE

With or without the symptoms of AMS, a person at high altitude may develop signs or symptoms of HAPE, such as:

  • difficulty breathing at rest
  • a cough with pink sputum
  • purple or blue discoloration of the mouth area or fingernails
  • extreme fatigue. 
  • See more symptoms of HAPE in Chapter 3 above.

It is critical to act immediately if anyone in your party has any of the symptoms of HAPE, which can be fatal even faster than HACE. 

Descend immediately, while the traveler is still mobile rather than waiting for severe symptoms that would force the victim to be carried. 

Physical exertion can worsen the problem in someone sick with HAPE, so it is important that they descend slowly and with physical assistance. 

Additional Options:
  • Oxygen (Even 2-4 l/m flow rates can make a big difference.)
  • The prescription medicine nifedipine can be used to treat HAPE — but again this is beyond the scope of this article written for lay beginners.15
  • Hyperbaric bags are used by mountaineering expeditions and mountain clinics to treat HACE. 16

Generally speaking, the treatments available to any traveler for a milder form of AMS is to refrain from ascending further until the symptoms resolve, and for HAPE or HACE, to descend as soon as possible.  

In all cases you can treat headache with ibuprofen or acetaminophen, and nausea medication with something like ondansetron.

With that, let’s debunk some of the more popular altitude sickness myths.

Chapter 6: Mountain Sickness Myths

Hiking near Murren in the Bernese Alps. ©YoWangdu.

It is astonishing how much misinformation you will find about altitude sickness. Here’s the truth about a few of the more pervasive myths:

Myth: Diamox hides the symptoms of altitude sickness

False. Acetazolamide, the prescription drug sold as Diamox, does actually accelerate your body’s natural acclimatization processes. 

Myth: If you are young and physically fit, you don’t need to worry as much about getting altitude sickness

False. Age and physical fitness are generally not considered risk factors for getting altitude sickness. Actually, there is some evidence that the risk of altitude sickness may decrease over age 50. And there is plenty of anecdotal evidence that young, fit people tend may tend to over-exert and try to push through altitude sickness, which can lead to severe illness or death.

Myth: You should slam water at high altitude

False. Before we get to the myth, we want to say that it is critical to hydrate sufficiently at high altitude. You need to be drinking enough water that your urine is the color of straw or champagne. If your urine is yellow, you are dehydrated. If dark yellow, you are extremely dehydrated. It’s easy to get dehydrated at high altitude for various reasons, including the fact that when you breathe in the mountains, you are exhaling moist air and inhaling cold, dry air.

However, there is a persistent myth that you should drink huge amounts of water. You need enough, but not too much. Drinking too much water can actually be harmful, as it dilutes your electrolytes. This can cause a potentially serious condition called “hyponatremia.” 

Myth: You shouldn’t take a shower or bath at altitude for the first few days.

False. This has nothing to do with your risk for getting altitude sickness and seems to be a myth propagated by Chinese tour companies for Tibet. We have asked some (very good) Tibetan guides about this, and they also insisted that it is correct. There is zero scientific evidence for this claim.

Myth: If you stop taking Diamox, your symptoms will “rebound”

False. Stopping Diamox simply slows down the accelerated acclimatization that you benefit from with Diamox. If your symptoms recur, you can always re-start Diamox. 

Myth: If you have been to high altitude and not gotten AMS, you won’t get it on subsequent trips

False. A prior history of altitude sickness is the strongest risk factor for getting altitude sickness. However, not getting altitude sickness on one trip does not shield you from developing it on later trips. There are many stories of high-altitude climbers and guides who ascend multiple times before suddenly developing AMS. 

Chapter 7: Real-Life Stories and Videos from Travelers

Now it’s time for us to share with you some real-life examples of traveler’s experiences at high altitude. 

Our main goal here is to give you a sense of what real travelers’ experience at altitude, and how they self-report feeling.

Please note that the opinions expressed in these videos and stories are the posters’ own, and should not be taken as expert advice. 

#1: VIDEO: At altitude in Argentina

A young climber at high altitude cannot speak at all normally, even though he seems fairly oriented. (And appears to understand that he needs help, which is often not the case with HACE victims.) Fortunately, his buddies descend with him, so that a few hours later and a few thousand feet down he seems much better.

Altitude sickness expert Peter Hackett notes that it is unlikely that the climber actually has HACE. Rather, Dr. Hacket told us 17, he is showing what is called a focal neuro deficit. He is not disoriented or confused, not drowsy, and his coordination is okay. Rather, he is just having trouble with speech. Still, Dr. Hacket notes,  laypersons thinking he has HACE is OK, since they will get him down, give him oxygen etc. 

Video: Altitude Sickness — High Altitude Cerebral Edema (HACE)

#2: VIDEO: At altitude in Nepal

Russell Hepton, The Trail Hunter vlogger, shares a day by day account of the effects of altitude sickness on his Lukla to EBC trek in Nepal. 

#3: STORY: At altitude in Peru

Lauren Mazzo writes about getting altitude sickness at 14,300 ft on a trek in the Peruvian Andes

I Got Brutal Altitude Sickness While Trekking in Peru — But It Was Still the Best Trip of My Life

#4: STORY: At altitude in Tanzania

Tim Moore describes his experience on the 5-day ascent of the highest mountain in Africa. Note that the rate of ascent on this climb was FAR faster than all recommendations, and why there is so much altitude illness on Kilimanjaro.

Kilimanjaro? Well, it nearly killed me

#5: STORY: At altitude in Tibet

Annie Groer recounts how she and some of her companions were shocked to feel awful on a short trip to Lhasa, Tibet. Check out the stories of other travelers she shares a bit down in the article. 

On a trip to the Himalayas, I learned about altitude sickness the hard way

#6: STORY: At altitude in Nepal

A trekker ends up at the hospital in Kathmandu after collapsing on the way to Dingboche from Tengboche. (Some minor misinformation here.)

Altitude Sickness — An Experience and a Lesson

#7: VIDEO: At altitude in Nepal

Ryan Purvis talks about his experience in the Annapurna range of Nepal.

#8: VIDEO: At altitude in Peru

You can see the progression of altitude sickness in Caro, from the Lots of Fresh Air blog, on her trek above 5000 m on the Huayhuash circuit in Peru, and fascinatingly, her recovery as she descends.

#9: VIDEO: At altitude in Tibet

Yolanda O’Bannon (co-author of this guide) and Meg Moser taped quick videos along the way of a 2017 journey to Mt. Kailash, and on the Ganden to Samye trek, to report on how they felt at altitudes on different days above 12,000 ft. 

Brief video from the top of the Dolma Pass to give you a sense of the breathing. It’s not easy to hear but the video pans to a small group of folks where Meg and our guide are helping a young Chinese woman who is dangerously ill on the pass. 

See the whole playlist here:

Video Playlist: How do you feel at high altitude in Tibet?

We recommend you check out “In Darchen, before beginning the Mount Kailash Trek,” and “Day 4 of Ganden to Samye Trek.”

Chapter 8: High Altitude Dos and Don’ts

Now that we’ve looked at how to identify, prevent and treat mountain sickness, let’s quickly review what to do before and during your trip.

Before you go


  • Plan a trip with a slow ascent. 
    • Avoid going from low altitudes to over 9000 feet in a single day. Once you are above 9000 ft, avoid moving higher than 1600 ft a day, and take an extra day at the same altitude every 3300 ft/ 1,000 m.18
    • Many guide services offer trips with shorter or longer acclimatization periods. Avoid trips that don’t adhere to recommended ascent schedules. 
  • If you have no choice but to make a rapid ascent, see a doctor about the possibility of taking altitude medication. 
    • And start the medication 24 hours before reaching high altitude. 17 (Diamox begins to work quickly, so starting it 24 hours in advance is mostly to see if you tolerate the medication.)
  • Know the symptoms of AMS, HACE and HAPE
  • PLUS, use a knowledgeable guide
    • If going on a guided trip, use an agent or guide who can tell you specifically what training s/he has in relation to altitude sickness prevention and treatment. And how they handle altitude sickness on the trip.

Part of Dzogchen Gompa in Kham, Eastern Tibet. ©YoWangdu.

Once you reach high altitude


  • Look out for yourself and your companions. 
    • Be prepared to stop if you or others exhibit symptoms of altitude sickness. Be prepared to go down if the symptoms worsen, even if it means not reaching your goal.
    • If you are hiking with a group of friends, discuss emergency scenarios ahead of time and agree on certain actions, especially not leaving anyone on their own. 
  • Drink sufficient water
    • Enough so that your urine is the color of champagne or white wine.
  • Stay warm. 
    • It is often cold at high altitudes and you don’t want your body to be fighting a drop in body temperature at the same time it is trying to adjust to high altitude. 
  • Consume enough calories for the level of exertion you are doing. There has long been a recommendation to eat plenty of carbs at high altitude, with the thought that carbs aid ventilation and efficient use of oxygen in your body. However, two of the altitude experts that we shared this document with commented that they think that the carb recommendation may be a myth, and that there is not good science to back it up. One notes that the impact of the metabolism of the carbs, which does take less oxygen than fat and protein do, may be overstated.


  • Ascend with obvious altitude sickness symptoms.
  • Take sedatives (like certain sleeping pills). Some sleeping pills are okay, according to this list created by altitude expert Peter Hackett and shared by another expert, Inga Aksamit.
  • Overexert yourself in the first 24-48 hours. Mild to moderate activity, like walking, is recommended.
  • Drink alcohol, which depresses breathing 
  • Drink excessive water. 
    • You need to drink enough, but if you over hydrate, you can cause a dangerous imbalance by diluting salt and other electrolytes. Drink enough so that your urine is champagne colored.

Chapter 9: Gold Standard Resources for Altitude Sickness Prevention

Now that you’ve mastered the basics of altitude sickness prevention, you may want to learn more. 

While learning about avoiding altitude sickness, we’ve explored A LOT of resources, and want to share with you a list of blue ribbon resources that we have found to be not only helpful and easy-to use but also authoritative and trustworthy.

Here they are:

Best of the Best

User-Friendly Online Guides


Video Series by MedWild


About the Authors

We, Yolanda O’Bannon and Lobsang Wangdu, had some up close and personal experience with altitude sickness on a trip to Tibet in 2002.

Never wishing to repeat that experience, we began to educate ourselves. Then, after opening YoWangdu Experience Tibet to help make Tibet travel more simple and ethical, we also became obsessed with helping Tibet travelers stay healthy at high altitude.

We’ve written extensively on preventing altitude sickness in Tibet, but lately we have seen a more general need to offer simple but evidence-based information to the general public.

With this guide, we hope to make it easy for new travelers to high altitude to stay healthy on their trips.

Special Thanks

Since we are not ourselves medical professionals or scientists, we asked a group of wilderness medicine experts to have a quick look at our guide.

We were, to be honest, amazed and honored by the quick, generous responses of this community of prominent, busy people obviously dedicated to helping people know and avoid the dangers of altitude sickness.

For their invaluable suggestions and contributions to the first draft of this text, we are extremely grateful to:

  • Inga Aksamit, RN-BC,MBA
    • A registered nurse, winner of the Outdoor Writers Association of California’s Best Outdoor Book and an administrator for the excellent Altitude Acclimatization Facebook group.
  • Peter Hackett, MD
    • Mountaineer, and world-renowned high altitude expert. Key author of the preeminent WMS guidelines for the treatment and prevention of altitude sickness.
  • Chris Imray, PhD, FRCS, FRCP, FRGS
    • Mountaineer who has climbed the highest peak on each of the 7 continents, and vascular / renal transplant surgeon at University Hospitals Coventry and Warwickshire.
  • Louis Reichardt, PhD
    • Prominent neuroscientist who is also the first American to summit both Everest and K2.
  • Tod Schimelpfenig
    • Twice awarded the Warren Bowman award for contributions to wilderness medicine by a non-physician, and Curriculum Director for NOLS Wilderness Medicine.

We would like to emphasize that while the suggestions and contributions of the above experts significantly improved this guide, that all remaining mistakes are, obviously, our own.

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Chapter 1
  1. Note that the percentage of oxygen in the air remains constant at 21% no matter the elevation.
  2. Volume Regulation and Renal Function at High Altitude across Gender
  3. Oxygen at high altitude 
  4. Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658 m above sea level: a cross-sectional study 
  5. The incidence, importance, and prophylaxis of acute mountain sickness
Chapter 3
  1. High Altitude Pulmonary Edema (HAPE)
  2. Direct communication between Tod Schimelpfenig and the authors of this article. 
Chapter 4
  1. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
  2. Altitude Sickness Prevention with Ibuprofen Relative to Acetazolamide
  3.  Direct communication between Dr. Peter Hackett and the authors of this article.
  4.  Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Acute Altitude Illness: 2019 Update
Chapter 5
  1.  U.S. CDC article on High-Altitude Travel and Altitude Illness, written by Drs. Peter Hackett and David Shlim.  See Diagnosis and Treatment section.
  2.  High-Altitude Travel and Altitude Illness (See Table 3-06)
  3.  High-Altitude Travel and Altitude Illness. See Diagnosis and Treatment section.
  4.  High-Altitude Travel and Altitude Illness (See Table 3-06)
  5.  High-Altitude Travel and Altitude Illness. See Diagnosis and Treatment section.
Chapter 7
  1.  Direct communication between Dr. Peter Hackett and the authors of this article.
Chapter 8
  1. High-Altitude Travel and Altitude Illness (See Box 3-05)

How to Prevent Altitude Sickness Naturally While Visiting Tibet

Tibet, fittingly known as the ‘Roof of the World’, is located at an average elevation of 4, 900m. It is the highest region in the world and Qinghai- Tibet Plateau is the highest plateau in the world. Some of the world’s highest peaks are located in Tibet. The highest mountain in the world, Mount Everest at an altitude of 8, 848m is located in the border of Tibet and Nepal. Thousands of people get to Tibet, in spite of its remotes, high altitude and basic facilities to get a taste of spirituality, to get a view of the mighty mountains, to see how it feels to stand on top of the world, to experience new culture, to learn a new religion, to drive in the highest highways, and to just stare into turquoise lakes etc. While people who want to travel to Tibet don’t mind the cold weather and high altitude, it is important to make sure that your body is ready for the sudden shift in altitude.

What is Altitude Sickness?

Altitude sickness is a natural reaction of your body while acclimatising to the new higher altitude. One of the main causes for AMS is the decreased oxygen at higher altitudes. Also known as Acute Mountain Sickness (AMS) people experience this in places higher than 3,000m. Most of the places in Tibet are higher than this level. Some of the common symptoms of AMS are nausea, headaches, dizziness, loss of appetite, shortness of breath, loss of sleep, and fatigue. Here are some tips to help with, prevent or reduce the chances of altitude sickness while visiting Tibet.

6 Natural Ways to Prevent Altitude Sickness

Ascend Gradually

Ascending slowly is one of the best ways to naturally reduce the chances of experiencing symptoms of altitude sickness. People who fly to Lhasa are most likely to get altitude sickness that is because of the sudden change in altitude. You are literally just flying from plain and landing in one of the highest regions in the world. While flying our body does not have enough time to acclimatise to the high altitude. It is recommended that you take a Tibet train to Lhasa to start your journey in this high land. While travelling by train, you move much slowly and ascend gradually across the different altitudes. Even if you feel symptoms of altitude sickness like shortness of breath, there are oxygen outlets in train that you can help yourself with. The only disadvantage of going by train is that it is time consuming.

Taking a Tibet train to Lhasa helps to avoid altitude sickness.

Climb High and Sleep Low

When you enjoy a trekking or climbing tour in Tibet, please ensure that you climb high and sleep low. Don’t be in a rush to gain dramatic increase in the elevation you are covering in a day. Always sleep in lower altitudes and sleep in the same altitude for at least two days for your body to acclimatise. Never ascend when you are experiencing symptoms of altitude sickness. It will only get worse, so climb down immediately.

Hydration is the Key

Be careful what you eat and drink during your Tibet tour. It is advisable to avoid drinking alcohol, intake of caffeine and smoke cigarettes at high altitudes. It is also advisable to not take any sleep medications and depressants as they limit the intake of oxygen. Drink more water, at least 2- 3 litres per day, as dehydration only makes it worse. The air is dry and dehydration only increases the chances of experiencing any of the symptoms of altitude sickness. As the weather is cold you might not really be thirsty but remind yourself to consume water at regular intervals. Hydration is the key to avoiding a host of symptoms like headache, nausea, fatigue, and dizziness. Butter Tea is a good remedy for altitude sickness; drink some butter tea as soon as you land in Lhasa.

Watch What You Eat

Eat lots of fruits, vegetables, and foods rich in carbohydrates. Eat energy bars and healthy snack bars. Have soup and energy drinks every day. Eat small but frequent meals. Avoid eating in food from street vendors as it might not suit your stomach. Add food like bread and grains in your daily intake. The high altitude does not overwork your lungs and affects the oxygen content in your blood; they also affect the fluid, salt, and electrolyte levels in your body. So to keep yourself healthy and enjoy the trip freely ensure that you follow the above mentioned diet.

Eat healthy food and snacks while travelling around Tibet

Don’t Overexert

Do not take part in physically demanding activities as soon as you arrive. Take time to acclimatise—at least 2 or 3 days in Lhasa city. Take part only in light activities for the first two days. The long drives, high treks, long cycle rides all should be done only after your body is well adjusted to the new high altitude. Since you are in a very high altitude, your body is already overworking and consuming a lot of your energy. Over working yourself with activities like trekking, running, or cycling will only tire you out and you may even experience frequent shortness of breath. Another nugget to remember is that to be careful not to catch a cold while travelling to Tibet. It only exaggerates the symptoms you experience with altitude sickness. It is also advisable to not bathe every day.

Don’t Be Too Nervous about It

While the thought of experiencing symptoms of altitude sickness be scary and uncomfortable, don’t sweat too much over it. In most cases, the symptoms you experience will subside over in a couple of days. Even if it gets serious there are plenty hospitals in Tibet, that can treat you properly and swiftly for it. Altitude sickness also has nothing to do with age, gender, or physical fitness. While it is advisable to get yourself in shape before travelling to Tibet, your fitness factor has nothing to do with altitude sickness. Anybody can experience altitude sickness irrespective of age, gender, and fitness level. Inform your guide if you are not feeling well, get some local herbs that help with the symptoms, carry portable small oxygen tanks with at all times, and be prepared. At the most altitude sickness can only be a minor setback in your trip. It will not ruin your trip.

Myths About Altitude — Institute For Altitude Medicine

Myth # 1 – Don’t use caffeine at altitude.

We don’t know where this false assumption came from, but likely from the fact that caffeine is a mild diuretic (makes you pee). The concern is that it could dehydrate you and contribute to altitude sickness. This concern is unfounded unless you drink pots of black sludge coffee a day and little else. In reality, caffeine stimulates your brain, kidneys and breathing, all of which are helpful at altitude. And for those people who drink several caffeinated beverages a day, stopping abruptly can cause a profound headache. See Dr. Hackett’s article on caffeine and altitude. 

Myth #2 – Diamox masks symptoms of altitude sickness.

Taking Diamox to prevent AMS will not mask symptoms. It works on the same pathway that your own body uses to help you acclimatize. It is a carbonic anhydrase inhibitor that makes you urinate a base chemical called bicarbonate. This makes your blood more acidic and therefore stimulates breathing thereby taking in more oxygen. It speeds up your natural process of acclimatization and if you stop taking it you will not have rebound symptoms. It is one of the main medicines doctors use to prevent and treat acute mountain sickness (AMS).


Myth #3 – Physical fitness protects against altitude sickness.

Physical fitness offers no protection from altitude illness. In fact, many young fit athletes drive themselves too hard at altitude prior to acclimatizing thinking they can push through the discomfort. They ignore signs of altitude illness thinking it can’t affect them because they are fit and healthy. Everyone, regardless of fitness, is susceptible to AMS.


Myth #4 – Drinking extra water will protect you from altitude illness.

Staying hydrated is important at altitude. Symptoms of dehydration are similar to AMS. In reality you only need an additional liter to a liter and a half of water at altitude. Too much water is harmful and can dilute your body’s sodium level (hyponatremia) causing weakness, confusion, seizures, and coma. A good rule of thumb to assess for hydration is to check your urine. Clear urine indicates adequate hydration, dark urine suggest dehydration and the need to drink more water.

Myth # 5 – Children are more susceptible to altitude illness.

Several studies have shown that children have similar rates of altitude illness as adults. No evidence exist that children are more susceptible to the altitude. If your child is otherwise healthy and the basic rules of acclimatization are followed they will likely do well at altitude. Children do get altitude illness and the main challenge in those very young is that they can’t communicate their headache and other symptoms. Excessive crying in a baby the first 1-2 days at altitude could be altitude illness. Children with AMS bounce back quickly with treatment as do most adults.

Altitude Sickness – Causes, Symptoms, Treatment, Diagnosis

The Facts

The higher you go above sea level, the less oxygen there is to breathe. When you reach elevations above 2,000 metres (6,500 feet), your body doesn’t always adjust quickly enough to the decrease in oxygen. This can lead to altitude sickness, which is actually a group of potentially life-threatening ailments. Acute mountain sickness (AMS) is the most common type. Other forms of altitude sickness attack the lungs and brain.

Anyone can develop altitude sickness. Not everyone gets it; the effects of altitude vary from one person to the next. Some adjust to the decrease in oxygen more easily than others. But the higher and faster a person climbs, the more likely altitude sickness will develop. About 20% of people who ascend above 2,500 metres (8,000 feet) in a day and about 40% of people who ascend above 10,000 feet (3,000 m) in a day will experience symptoms. Children are the most susceptible. Surprisingly, the risk is twice as high for people under the age of 60 years.


All forms of altitude sickness are caused by low levels of oxygen at very high altitudes. These lower levels result in hypoxia, a shortage of oxygen in the body’s tissues. The effects of hypoxia may be mild or even unnoticeable. Altitude sickness is most likely to occur with a rapid increase in elevation, as well as by the cold experienced at high altitudes.

People can adjust to the effects of hypoxia at high altitudes, but only up to a point. At elevations up to 3,000 metres (10,000 feet), most people have no problems after a few days. But no one can survive permanently above 5,100 metres (17,000 feet). At the elevations reached by mountain climbers, bottled oxygen often becomes necessary.

Risk factors for altitude sickness include:

  • abuse of narcotics
  • being overweight (although some people do not consider this a risk factor)
  • some chronic diseases
  • fatigue or overwork
  • heavy drinking
  • past history of altitude sickness
  • rapidly increasing altitude too quickly
  • living near sea level
  • sleeping at too high of an altitude

Children are especially vulnerable, and can experience high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) below 2,500 metres (8,000 feet). Men are 5 times more likely than women to develop HAPE, but acute mountain sickness (AMS) and HACE affect men and women equally. If someone has had altitude sickness before, they have a 3 times greater risk. If someone usually lives below 3,000 metres, they are at more than 3 times the risk of those who reside at higher altitudes. However, if someone lives at a high altitude, an increased risk can develop even after a brief stay at lower elevations. Being in better physical condition does not protect you against altitude sickness.

Symptoms and Complications

The most common form of altitude sickness is acute mountain sickness (AMS), which can begin at elevations as low as 2,000 metres (6,500 feet). If AMS develops at any elevation, it causes tiredness and nausea. It can also cause swelling of the face and hands, difficulty sleeping, dizziness, and severe headaches. Symptoms will generally develop 6 to 10 hours after ascending to a high altitude. Exercise tends to make symptoms worse; however, some experts believe moderate exercise on the day of arrival will help the body acclimatize more quickly. AMS is rarely fatal. If someone with AMS remains at a high altitude, it will often disappear after a few days when the body adjusts to the higher elevation.

However, AMS can be a warning sign of high altitude cerebral edema (HACE). HACE causes swelling in the brain that can result in coma and death within hours. Early signs of HACE include severe headache, confusion, drowsiness, and hallucinations, as well as staggering or stumbling. A person with HACE must descend to a lower altitude immediately to prevent serious consequences.

High-altitude pulmonary edema (HAPE) develops one to three days after a rapid ascent above 2,500 metres (8,000 feet). When most people climb this high, fluid begins to accumulate in their lungs. With HAPE, the fluid builds up more quickly than it can drain. People become so breathless they remain unable to breathe normally even after long rests. Their skin turns blue, and they may cough up frothy, pink sputum and eventually fall into a coma. If not treated immediately and moved to a lower elevation, people with HAPE can die from the illness. Both HACE and HAPE can develop without AMS occurring first.

Altitude sickness can be complicated by any chronic illness. It can also be complicated by other high-altitude health problems such as frostbite, blood clots in the legs and lungs, dehydration, and swollen feet and ankles.

Making the Diagnosis

Symptoms can only be experienced at high altitudes. Because the symptoms can be caused by flu or hypothermia, diagnosis is made after ruling out other possible illnesses. HAPE can be confirmed with a chest X-ray.

Treatment and Prevention

AMS symptoms usually disappear after 2 days of rest at the same altitude. A medication called acetazolamide* can be taken to help someone adjust. This medication can prevent or lessen symptoms. Once symptoms subside, someone with AMS should be able to ascend to higher altitudes. If symptoms don’t go away, descending 300 metres (1,000 feet) usually helps. Painkillers (e.g., acetaminophen, ibuprofen) are effective for the headache. Slowing down breathing may help relieve headache and dizziness.

Therapy for HAPE or HACE always requires immediate but slow descent to a lower altitude. Treatment consists mainly of bed rest and doses of pure oxygen. Other medications for HACE (e.g., dexamethasone to reduce swelling) and HAPE may be used. When promptly treated, people usually recover from HAPE within 2 days.

The best prevention is to always allow the body to acclimatize to altitudes higher than those the body is used to:

  • Start slowly – begin at an altitude of than 2,700 metres (9,000 feet).
  • Allow time to adjust – rest a day after arriving.
  • Take it easy – high altitudes make normal activities more difficult. Slow down if you are out of breath or tired.
  • Limit ascent – don’t climb more than 900 metres (3,000 feet) per day. If at 3,700 metres (12,000 feet) or above, don’t climb more than 300 metres (1,000 feet) per day.
  • Sleep at a lower altitude. At high altitudes the blood oxygen level may fall even lower when sleeping. If above 3,400 metres (11,000 feet) during the day, spend nights at 2,700 metres (9,000 feet) or lower. “Climb high… sleep low.”
  • Every third day, spend at least 2 nights at the same elevation.
  • It’s also important to keep well hydrated. Drink plenty of fluids, and avoid alcohol, cigarettes and medications which can aggravate symptoms. Do not take sleeping pills as they may worsen the condition by slowing down your breathing thereby causing more hypoxia.
  • All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Altitude-Sickness

90,000 Head of the outpatient and procedural departments of the Krasnodar balneological hospital, gastroenterologist, Alexandra Chabrovskikh spoke about what a detox really is and why almost any disease can be cured with its help.

– In the context of a healthy lifestyle trend, the word “detox” is increasingly appearing. At the same time, many still do not fully understand the meaning of this concept. Please tell our readers what detox is in its true, medical sense.

– Detox or, in its more scientific formulation, detoxification is a complex of procedures aimed at removing toxins from the body. Toxins are quite dangerous substances that, accumulating in the intercellular fluid, cause a strong destructive effect on the body. In fact, it is a poison, and given its extensive group of origin, it enters the body of almost every person. Toxins lie in wait for us everywhere: in the air, food, water, clothing. So, the detox procedure just involves removing toxins from the intercellular fluid through the intestines, kidneys, lungs or skin by stimulating the lymphatic system.

– What are the consequences for a person who ignores the detoxification procedure?

– The human body is a self-cleaning system. This property is inherent in him by nature. But there may be a moment when its own reserves are depleted, and the body can no longer cope on its own. Then toxins begin to accumulate in it, which leads to the occurrence of any disease. Detox, being a preventive procedure, helps to prevent the accumulation of toxins, and hence the appearance of these very diseases.That being said, detoxification for recovery can sometimes be the most viable option. Indeed, often people, starting to feel unwell in any area, try to overcome it by taking medications. But since the cause of such ailments can be an excess of toxins, for recovery it is enough to free your body from them, without taking any medications, which, by the way, sometimes only aggravate the general state of health.

For example, a person has a headache, he begins to take painkillers, which in turn have a detrimental effect on the kidneys; kidneys got sick – they began to treat them, and so on.The chain can be infinitely long, and the result is undermined health. But after all, at the source of everything, perhaps, there is precisely the intoxication of the body, the first symptoms of which are, among other things, headaches. And it turns out that it was enough to carry out the detoxification process, which would save not only headaches, but also prevent the development of chronic diseases.

– There are several detoxification courses listed on your hospital website. They differ in the number of days and procedures required to complete.How do you know which course is right for each specific person?

– We can tell which course is suitable for a particular patient only by examining him. As I said, this is very individual and depends on the state of the human body, to what diseases it has a predisposition and how often it performs similar procedures.

One of the most modern and accurate programs for examining the body is a genetic study, which allows you to identify a person’s predisposition to certain diseases and select an optimal and effective detoxification program based on these data.

The difference between our courses in the number of required procedures and the period of passage is primarily due to the patient’s state of health. The shortest, 1-3-day courses are supportive and are more suitable for those who have already completed a comprehensive program. A complete detox, allowing you to completely cleanse the body, lasts at least 7 days. It should be chosen if you have not “cleaned” for a long time, or are doing it for the first time.

– Can a person independently understand that he needs detoxification?

– Maybe.For example, if a person feels constant fatigue, drowsiness, and is often in a decadent mood. It must be understood that any disease has a common forerunner, expressed primarily by psychological anxiety. When there is a feeling of severe discomfort, a feeling that something is missing, dissatisfaction – all these are possible signs of an excess accumulation of toxins in the body, which is time to get rid of.

– During our conversation, you have repeatedly mentioned the connection of toxins with the occurrence of dangerous diseases.And which ones?

– In fact, there is no disease that would not be associated with a disruption of the lymphatic system. For the body to be healthy, its cells must be healthy.

In this sense, toxin poisoning contributes to any disruption of the body’s activity. First of all, detox is needed for people with chronic diseases, allergy sufferers, those who have problem skin, disrupted gastrointestinal tract function, problems with obesity, infertility, frequent headaches, physical inactivity.In addition, detox is required for those who abuse the wrong diet, alcohol, cigarettes, coffee and generally lead an unhealthy lifestyle. Systematic contact with consumer goods, plastic containers or artificial leather also provoke toxin poisoning. As you can see, many are at risk, because detoxification is one of the most important areas of modern medicine.

– Does detoxification help you lose weight?

– Yes, but that is not his main goal.Rather, a nice bonus. A comprehensive detoxification course involves not only medical procedures associated with cleansing the body, but also a partial change in lifestyle. This means changing your diet and avoiding junk food. We also prescribe physical training for our patients as part of a health-improving course. A wellness menu is selected that ensures a balanced work of the gastrointestinal tract and the whole organism as a whole. All this work, which we do together with our patient, leads, among other things, to weight loss.

– Since a person is forced to follow a strict diet during the treatment, then for sure at first he is experiencing severe hunger. Do you have any special techniques to alleviate this condition so that the patient does not break loose and eat a conventional grilled chicken during the breaks between procedures?

– We formulate the diet in such a way that the patient adapts to the new beneficial regimen as quickly as possible and accepts it with ease. What is important, and this is another undoubted plus of going through the detox, is that at the end of the course a person perceives the new diet as quite familiar, and the refusal of junk food no longer seems so painful to him.He is just accustoming himself to a healthy lifestyle. After all, the feeling of lightness and comfort that a person receives after cleansing the body becomes much more valuable to him than the temptation to break the diet.

– How often do you need to detox?

– Preferably twice a year. At the same time, as I said, having undergone complex treatment, in the future, you can do with short-term courses, just to keep the body in good shape.

– And finally, tell me, what is the difference between your detox procedure and a similar offer in other clinics?

– For starters, it should be noted that detoxification is one of the core areas of our clinic.The Krasnodar Balneological Clinic has been working with detoxification programs for over 40 years. Therefore, the practical success of our program is confirmed, so to speak, by historical experience. We are followers of the Soviet approach to the treatment of diseases, which primarily meant prevention. This was the basis of the main principle of high-quality Soviet medicine: instead of curing a disease, it is better to prevent its occurrence. This, by the way, is in line with the current state health program.It is not for nothing that Veronika Skvortsova (the Minister of Health of the Russian Federation – editor’s note) stated that now medicine as a whole is being reoriented towards prevention. And we are talking not only about medical examination. We are now in the wake of the development of genetic testing, which, using DNA analysis, allows us to determine the individual tendency of a person to a particular disease. Therefore, prevention is today the flagship of the development of medicine. And since our treatment is focused primarily on her, we also have a great advantage in this sense.

Over the entire period of the work of our center, more than half a million people have passed the courses of cleansing the body. This allowed our detoxification program to overcome the long path of successive medical technologies and take shape today into one of the most advanced and effective on the Russian market. We approach the cleansing of the body in a complex way, acting on the lymphatic system of the body, a kind of natural highway through which toxins and metabolic products not needed by the body are removed.And this is true detoxification. Unfortunately, many, using the term “detox”, offer only various juices, dietary supplements or regular fasting. Even if there is some benefit from this, then it definitely cannot be called a detox. Our cleansing program is attended by highly qualified specialists from various fields: therapists, physiotherapists, clinical lymphologists, gastroenterologists, nutritionists. We offer a full range of activities for high-quality body recovery.

Plus, as I said before, we practice a personalized approach. For each patient, an individual composition of the program is selected in accordance with the characteristics of his body. And do not forget that we are primarily a balneological hospital and we build our treatment primarily on mineral water, the springs of which are located in our territory. Our healing waters are very useful in themselves, and in combination with medical procedures, they significantly speed up the process of detoxification and healing of the body.

And the territorial factor is also important. Since our hospital is located in the center of Krasnodar, residents of the city can undergo treatment without actually interrupting their usual rhythm of life. Patients have the opportunity to visit the hospital, for example, in the evening after work, and then go home. The main thing is to follow the doctor’s instructions! And for those who want to stay in the hospital throughout the course, we have comfortable hotel rooms, in which the patient will receive comprehensive treatment under the constant supervision of doctors.

Krasnodar Balneotherapy

Krasnodar, st. Herzen 267, tel .: 8 (861) 201-9-201

www.kuban-kbl.ru, www.detoxkrd.ru

There are contraindications, it is necessary to consult a specialist

90,000 Coronavirus Cave. Several miners from the PRC suffered from a strange pneumonia back in 2012

Chief US infectious disease specialist Dr. Anthony Fauci called on China to disclose information about six miners who contracted an unknown virus in Mojiang County in 2012.The expert turned to the Chinese authorities at the beginning of the month amid active discussions in the United States of the laboratory hypothesis of the emergence of the coronavirus. According to Fauci, the incident with sick workers at the mine could shed light on the origin of COVID-19 and bring closer the answer to the question of where the coronavirus came from. We tried to figure out what is known about the “Mojiang virus” and whether it is associated with a pandemic.

In April 2012, six miners between the ages of 30 and 60 were clearing bat faeces from an abandoned mine in Yunnan Province.Later, they were all admitted to a hospital in Kunming County due to a strange illness. The workers showed roughly the same symptoms – cough, fever, head and chest pains, and shortness of breath. Despite the efforts of doctors, three out of six miners died from the effects of pneumonia.

What did the scientists find in the mine?

The mine itself, where the miners worked, is located in Mojiang Hani Autonomous County in southwestern China. This is about 1.5 thousand km from Wuhan, the place where COVID-19 was first discovered.In the same year, experts from the Wuhan Institute of Virology (WIV) went to the mine to determine the cause of the illness and death of the miners.

Scientists managed to get a sample of the “Mojiang virus” (paramyxovirus MojV), which was later found in rats. However, studies have not confirmed that he caused the disease in people. A year later, another virus was discovered in the same mine, the beta-coronavirus of bats RaTG13. As it turned out in 2020, this is the closest known relative of SARS-CoV-2 (96% similarity).However, despite the high similarity, RaTG13 cannot be effectively introduced into the human body.

According to Reuters, from 2012 to 2015, TID researchers identified up to 293 coronaviruses in and around the mine. In November 2020, the institute disclosed the existence of eight other SARS-like coronavirus samples found in the same locations.

What caused the workers to die?

According to Dr. Shi Zhengli, the lead virologist of the UIV, known as Lady Bat, a fungal infection may have caused the symptoms of pneumonia in miners.Dr. Shi is leading IWI’s work on emerging infectious diseases, and over the years, her group has collected more than 10,000 bat samples from all over China.

“The mine smelled awful,” the doctor told Scientific American. “Bat guano, covered with fungus, filled the cave.” According to the virologist, the fungus turned out to be a pathogen, due to which the miners fell ill.

In a study that Lady Bat and her colleagues presented last November, experts re-tested 13 serum samples from four miners and found no indication that they were infected with SARS-CoV-2.At the same time, Dr. Shi did not provide in any scientific journal a detailed description of what the miners were still ill with. In a recent interview with The New York Times, she promised to publish such an article soon.

At the same time, as pointed out by Reuters, the Chinese authorities have not provided any detailed information about the miners who fell ill in 2012. Only their names, age and symptoms of the disease are known. All this was published in 2013 by Li Xu, a graduate student of Kunming Medical University, who treated miners.His work is still available in the Chinese online scientific articles database. In his study, he concludes that mountain women died from a coronavirus similar to the one that caused SARS. A prominent Chinese epidemiologist and pulmonologist Zhong Nanshan, who studied the medical history of miners, agreed with his conclusions.

Some other experts also point out that if it was a fungal disease, then only antifungal drugs could stop the disease. In addition, the state of blood vessels, thromboembolism and a reduced number of lymphocytes still indicate viral pneumonia.

Last year, Lee’s dissertation was actively circulated on the Internet as alleged proof that a coronavirus, very similar to SARS-CoV-2, was killing people almost a decade ago. The methods of treatment used by doctors then were striking. This is the use of steroids, antibiotics, blood thinners, as well as the connection to mechanical ventilation. Almost everything that is now being treated with COVID-19 patients around the world.

Others believe that the document indirectly confirms that the TID received, studied and conducted experiments to “enhance the function” of viruses found in the mine.

“What do the medical histories of these people say? Did they have a virus? What was it? It is possible that the origins of SARS-CoV-2 were in that cave and either began to spread naturally or passed through the laboratory,” early June Dr. Fauci.

Several other professionals are also asking similar questions. “In his dissertation, Dr. Li writes that four miners have tested positive for antibodies against SARS-like CoV. However, questions remain about which antigen and protocol were used to detect antibodies in patients.”Why is this information not available in any of the open studies conducted by TID? Why were severe cases of pneumonia in 2012 not mentioned in any of the TID publications until 2020? Have any other SARS-like viruses been isolated from bat fecal samples collected in 2012-2013? Why were no cases of infection by miners in Mojiang reported to any official treatment organization such as WHO in 2012? Why did programs like PREDICT not refer to cases of fatal pneumonia as a mini-outbreak? Was the Mojian mine closed when? “

In addition, experts are concerned whether the samples of the miners’ analyzes are still stored in the TID and are they available for study by other specialists?

What’s going on in this mine now?

The Chinese authorities do not allow any independent research to be carried out in the mine.According to The Wall Street Journal (WSJ), a video surveillance camera and a checkpoint were installed near this facility.

Foreign journalists have already been detained in this position several times. Including the WSJ reporter, who drove up to the mine on a mountain bike. According to the newspaper, the police interrogated him for five hours and demanded that the photos of the mine be removed from his mobile phone. Other journalists were not allowed to the mine, arguing that the region is unsafe due to wild elephants.

The villagers also allegedly told a WSJ reporter that local authorities had asked them not to discuss the mine with outsiders. At the same time, the publication notes that the entrance to the object looks overgrown and abandoned, no signs of research in this place were observed.

Dmitry Belyaev

90,000 Scientist: “a complete rejection of antibiotics will not kill super-bacteria”

As noted by Gelfand, pathogenic microbes, as a rule, live inside the body of humans or other animals and rarely encounter antibiotics.Their “cousins” from the soil, on the contrary, are constantly at war with each other with the help of “chemical weapons” and have genes for resistance to their action. And their simultaneous entry into an environment rich in antibiotics leads to predictable consequences.

“Let’s say vancomycin-resistant enterococci are almost certainly a” product “of animal husbandry. Fortunately, triclosan soap was banned last year as antibiotics in animal husbandry in the US since January 1 a dreadful situation – 80% of antibiotics were used to treat livestock, and most of them were used in real medicine.All this was a colossal waste of intellectual potential, “Gelfand concludes.

– Mikhail Sergeevich, is it possible to predict which direction the evolution of bacteria will take and create antibiotics “in reserve”?

– In the most general form, such studies can be carried out, but if you study each specific case, then probably not. At one time there was a theory that antibiotics should be of a narrow spectrum in order to slow down the rate of adaptation of bacteria to them, since the “antidote” will look for one, not several microbes.

Pharmaceutical companies did not agree to this for two reasons – requirements for the quality of diagnostics are arising sharply, which was difficult to do until recently. In addition, development costs will be the same as broad spectrum antibiotics and the market will be very small. Therefore, no one particularly tried to go this way, neither private traders nor the state. The state could help here by setting rules for the use of antibiotics, which, in principle, is already being done.

– If the fight between antibiotics and bacteria continues, which will win – will the “superbugs” survive or will the “load” of their drug-fighting adaptations destroy them?

– I think that bacteria will win in any case simply due to the fact that there are a lot of them and they are very diverse.There are examples when humanity conquered diseases, but in all these cases it was not drugs that conquered them, but vaccines. Vaccines work well against viruses, which are relatively simple, and against bacteria, to put it mildly, they are not insanely effective. They reduce the likelihood of getting sick, facilitate the course of the disease, but do not guarantee protection.

In addition, many viruses work against specific species of animals, and bacteria can live in different representatives of the living world.Therefore, I think that bacteria will always be with us. Even if we create a kind of super-antibiotic that kills absolutely all microbes, it will kill not only pathogens, but the intestinal flora, without which we cannot live.

First aid kit for a hike. What to take in a tourist’s first aid kit?

6 February 2019

The composition of the tourist’s first aid kit is a big topic for discussion. Often, even doctors cannot come to a common opinion on what drugs and means should be included in a tourist’s medicine cabinet.This is due to the fact that each of us has our own diseases, different sensitivity to drugs, and the like. Besides, hikes are different, and the needs, as well as the dangers, in them can be different. In addition, not every physician will want to take responsibility and recommend that a person without special knowledge use drugs at his own discretion.

My first aid kit is a first aid kit that was collected for me (and partly for that friend who did not take the first aid kit).When completing an individual first-aid kit for a hike, I take this principle into account for the selection of medicines and their quantity, so there is the most important thing. Below is the composition of the first aid kit that I use for short hikes, trips up to one week. This composition of the tourist’s first aid kit was developed for summer hikes for a long time, based on what drugs I had to use and what problems can happen during hikes.

See end of publication for complete list and disclaimer.

Note that is not enough to buy tablets at the pharmacy. They will not bring absolutely any benefit if you do not know how to use them, do not know the contraindications and incompatibility of drugs. They can easily hurt. For correct use and maximum preservation of your health, you should study the features of their action, know the dosage and restrictions in the methods of administration.

For example, I know for sure that the first intake of loperamide is two tablets, plus one after each emptying, but it is better not to eat more than four of them a day.It is important to know your first aid kit and be able to use it. The general rule of drug use is: “ If you don’t know, you don’t apply! “It is also important to know your body, contraindications, chronic diseases or other” sores “that may worsen during the hike.

Medicines, dressings

Medicines are not medicines in and of themselves. In this list, I have included additional items that can help with medical problems, tools, dressings that may be needed on a hike and should be in a travel medicine cabinet.

Elastic bandage

Elastic bandage is used to prevent injuries, as well as to fix muscles, joints and limbs in general. It must be in the first aid kit, since one of the most common problems in a hike is with the musculoskeletal system. Elastic bandage can relieve knee pain , fix ankle joint, sprain, dislocate or fracture, support muscle, etc.

The assortment of elastic bandages in pharmacies and medical equipment stores is now simply huge: these are self-fixing, and Velcro bandages, and ordinary bandages with fleas for fixing.The bandage should be chosen based on one’s own capabilities and desires. If you are buying a simple, inexpensive elastic bandage – put a couple of pins in the medicine cabinet – you will need it to fix it.

Non-sterile bandage

You need a bandage on a hike! Minimum one per person. Better – more than . It is optimal to buy a narrow bandage of medium length, which will be convenient to use, for example 10 cm x 5 m . Mountain rescuers say there are never too many bandages in case of an emergency.The specific number of bandages should be chosen depending on the difficulty and danger of the hike. Often, the main amount is taken in group first-aid kit , and in personal ones, each participant in the hike has his own separate one. For short hikes, you can limit yourself to one.

To overpay, although a penny, for sterile bandage is not worth it. Its sterility disappears as soon as you open the package with dirty tourist hands. In addition, there are few chances to keep it intact in a travel first-aid kit, constantly dangling in a backpack.

Plaster in roll

The plaster must be in the tourist’s first-aid kit! They can fix a bandage, bandage, additionally fix bactericidal patches and use in many other situations. Plus, a travel medicine chest patch can help repair a broken tent arch or torn sandals. The optimal width is 2 cm. Only fabric (not paper) is suitable. Before putting it into a first-aid kit, flatten the roll of the plaster so that the coil on which it is wound does not take up extra space (it does not fit on a plastic coil either).Good but somewhat more expensive patches are sold under the brand name 3M.

Bactericidal plaster

Different is needed. It may require different shapes, sizes. Drops are large and small, and cuts are long and short. In the pharmacy, you can find plasters for every taste.

Also, just in case, it is worth having a plaster from different manufacturers – so it is more likely that one of them will stick to the skin when the others deteriorate, or it simply turns out that half of the plasters taken are of poor quality.From my own experience, for a tourist first-aid kit, it is better to buy a bactericidal plaster with sheets (wide strips) intended for cutting. Once this was made with green gauze in the center. Now this patch is available in other types. Its advantages are that you can cut a strip of the desired width, and the glue holds many times better than in small, individually wrapped plasters from a box. The disadvantage is that you need to have scissors for such a patch.

Atraumatic scissors

You can buy small medical ones, take manicure or use scissors from a multitool or a Swiss knife, such as the Victorinox Climber.However, the compact tactical medical scissors are probably the best choice. They have rounded ends to minimize the risk of injury to the victim in situations where it is necessary to urgently cut the clothing on his body. Of course, this can be done with a knife, but this way the risk of injuring a person even more only increases. Plus, it is not always convenient and can be done quickly. Medical scissors will also be much more convenient for cutting a bandage, plaster, etc.p. Take up a minimum of space, compact and lightweight.

Beware of cheap Chinese tactical scissors fakes – they are usually disposable. Very disposable!

Alcohol wipes

More information about antiseptics on the hike is below. Alcohol wipes are listed immediately after the bactericidal patch, because from our own experience, in the vast majority of cases, they are used specifically to prepare the skin for gluing the patch. It’s no secret that a bactericidal patch glued to a dirty foot over dropsy will fly away very quickly.Therefore, the area of ​​the skin to which it is glued must be clean, dry and fat-free. Only in this case can one hope for a long-term effect.

Alcohol wipes are marketed as “injection wipes” , but the essence remains the same. This is a small piece of nonwoven fabric soaked in ethyl or isopropyl alcohol. They are also great for the antiseptic treatment of small wounds.

Medical wipes, cotton pads, cotton swabs

Cosmetic cotton pads can be used instead of cotton for wound care and other needs.They leave behind less lint and are more convenient to use than cotton wool. A few cotton swabs are also helpful. It is more convenient with them to treat small wounds , or damage in hard-to-reach places. For example, scratches near the eyes. For everything else, you can tear off pieces of bandage or put special medical gauze napkins in your first-aid kit. They are sold sterile packed in a tight little package, so they are convenient: they do not leave lint in wounds, unlike cotton wool.

Medical nitrile gloves

You don’t require a medical certificate with tests for all possible infectious diseases for everyone with whom you go camping, right? In an extreme situation, it may happen that you have to contact the open wounds of other people, and in this case it is better to protect your health and life from surprises that are transmitted through blood and other biological fluids. Gloves can be latex, but nitrile are more resistant to mechanical damage, and they are hypoallergenic.

Antiseptics, wound care

In addition to, in fact, the antiseptic chlorhexidine mentioned in this section, ethyl and isopropyl alcohol , which are often used in medicine, have an antiseptic effect, but it is not very convenient to take them on a hike due to somewhat limited versatility. You can also equip a first-aid kit on a hike with iodine, but it should be remembered that you cannot pour it into the wound, because a chemical burn will also be added to the injury.Zelenka is not used almost anywhere in the world – its effect is scanty.

Hydrogen peroxide

For washing deep wounds. Due to the formation of foam during the reaction in the human body with the enzyme catalase (decomposition into water and oxygen), it carries dirt from the wound to the surface. It has no antiseptic effect, does not disinfect , but is well suited for washing wounds. You can not take it, the ratio of need and indispensability to size / weight is very low.


Substance with antibacterial properties. Used as an antiseptic , for washing wounds, scratches. Transparent, does not leave marks on clothes, equipment. Effective against a wide range of bacteria and fungi. It is quite suitable for use in a hiking trip instead of traditional brilliant green and iodine. Does not burn tissue, but is not recommended for the treatment of mucous membranes. Simultaneous use with iodine is not recommended.

The advantage of chlorhexidine in comparison with other substances that are taken on a hike as antiseptics is its simplicity in terms of transportation, it does not stain equipment, it is sold in convenient plastic bottles with a dispenser.Chlorhexidine can be taken in the tourist medicine cabinet as the only antiseptic for external use.

If Chlorhexidine is not satisfied with something, you can consider the option of other antiseptics, for example, Dekasan, Gorosten (spray), povidone-iodine (Betadine, Betayod) – an alcohol-free iodine-containing antiseptic, but it is not cheap.

Alcohol is also an antiseptic that suppresses bacterial activity, but it has drawbacks : it “burns” living cells and sooo “burns”.Alcohol can be used on healthy and intact skin (for example, before injections).

Ammonia solution (ammonia)

Not quite an antiseptic. More precisely, it is not an antiseptic at all, but it is also sold in bottles, so I got into this section. 🙂

Aqueous solution of ammonia (ammonium hydroxide), usually 10% concentration. A volatile liquid with a very pungent odor. The main purpose in field conditions – for arousal of respiration with dizziness, or for removing from a fainting state.It can also be used to stimulate vomiting or externally in certain situations, which are not worth talking about within the framework of this material.

Ammonium should be used with caution . It should be understood that loss of consciousness, is a symptom of – an indicator of a problem. One of these problems leading to dizziness is a deterioration in the oxygen supply to the brain. Roughly speaking, when the brain realizes that little oxygen gets to it, it instructs the body to move to a horizontal position and turn off functions that are not critical for life.Taking a person out of a state of fainting requires a set of actions, and not just “let the ammonia smell out.” However, this topic goes beyond the scope of a travel first aid kit. Ammonium is just one of the possible steps of the algorithm.

Attention! If used incorrectly, ammonia causes burns to the esophagus and stomach (in case of ingestion), reflex respiratory arrest (if inhaled in high concentration). Ammonium cannot be sniffed directly from the jar. They need to moisten a cotton swab and quickly hold it near the nose (no more than 1 second).Otherwise, you can cause burns to the mucous membranes.

There are ammonia wipes , similar to alcohol, intended for single use. There are also disposable capsules with foreign-made ammonia. This is an ideal option for hiking, because ammonia is rarely used, and you really don’t want to carry a glass jar in a travel medicine cabinet. Unfortunately, it is almost impossible to find such forms in pharmacies.

Medicines in a first aid kit

Ketorolac (Ketanov)

Refers to the group of non-steroidal anti-inflammatory and antirheumatic drugs.In fact – non-narcotic analgesic . Designed for short-term treatment of moderate to severe pain. In other words, an anesthetic for injuries, severe toothache, myalgia, neuralgia, sciatica, dislocations, etc.

Do not use with acetylsalicylic acid (you shouldn’t take it in the medicine cabinet at all), diclofenac sodium, ibuprofen. Remember that no analgesic drug is recommended to be used alone, without the advice of a specialist.

Ketorolac in a tourist medicine cabinet can replace Dexketoprofen (Dexalgin, Depiofen).It has a stronger anti-inflammatory and analgesic effect, can eliminate renal pain, but carefully read the instructions carefully.

The strongest available drug should not always be used for pain relief!

Diclofenac sodium

Anti-inflammatory, analgesic and antirheumatic agent. Most often in field conditions it is used for inflammation of soft tissues and the musculoskeletal system (joints, muscles, tendons).In case of inflammation caused by trauma or rheumatic diseases, it leads to a decrease in pain, tissue edema and a reduction in the period of renewal of the functions of damaged joints, ligaments, tendons and muscles. Cannot be used in conjunction with ibuprofen, ketorolac and other non-steroidal anti-inflammatory drugs!

Effective as a topical gel / ointment (eg for knee injuries), or as a tablet. The tablet form is best used when the ointment is inconvenient to use (for example, on a winter hike).But it should be remembered that diclofenac negatively affects the gastric mucosa, it cannot be taken on an empty stomach, and it is dangerous for people with ulcers or gastritis. When taken simultaneously, diclofenac and paracetamol enhance the action of each other.

Analogue for diclofenac tablets – Meloxicam , which is less aggressive on mucous membranes when taken orally. Considering the side effects, in a tourist trip, should be given preference to local remedies – gels and ointments based on diclofenac sodium.These funds are highly desirable in a first aid kit.


In the instructions for paracetamol, it is written about its indications: headache, including migraine and tension headache, toothache, back pain, rheumatic pain, muscle pain, recurrent pain in women, moderate pain in arthritis, relief of symptoms of fever and pain in colds and flu.

And in short: paracetamol is taken as antipyretic for high fever, headache, etc.n. Paracetamol is a part of a large number of different drugs with combinations of active ingredients for the treatment of flu, colds. In many cases, paracetamol can be substituted for ibuprofen. The second also has an anti-inflammatory effect.


A drug for the symptomatic treatment of headache, toothache, neuralgia, back pain, joint pain, muscle pain, rheumatic pain, symptoms of colds and flu. Cannot be taken together with other non-steroidal anti-inflammatory drugs (NSAIDs) .If Paracetamol is more focused on lowering the temperature, and often does not work for individual people, Ibuprofen can be a substitute for it in the first aid kit for a hike.


The drug belongs to the group of proton pump inhibitors. Easier – a means for inhibiting the formation of hydrochloric acid in the stomach. It is used for the treatment of stomach and duodenal ulcers, for chronic gastritis, gastrointestinal bleeding, etc. In a tourist medicine cabinet, it is important to use Omeprazole for prevention of gastric lesions and duodenal ulcers with non-steroidal anti-inflammatory drugs (NSAIDs) – Iboplofacinom , Dexketoprofen and others.Why is it important? NSAIDs, when taken in pill form, negatively affect the stomach lining and can cause pain, ulceration, and even more serious problems. Especially when taken on an empty stomach. Omeprazole can also be used for the symptomatic treatment of heartburn.


Combined remedy for pain caused by spasm of smooth muscles of internal organs. For those who have problems with the kidneys, gastrointestinal tract, urinary tract (e.g. gallstone disease, pancreatitis, etc.)NS.). You can take other similar drugs: no-shpa, drotaverine, etc. Spazmalgon, in addition to the antispasmodic effect, also contains an analgesic. It is advisable not to take Spazmalgon with other drugs, especially with other analgesics and non-steroidal anti-inflammatory drugs, such as ketanov, ibuprofen, diclofenac.


Tablets for diarrhea. Even a small travel first aid kit cannot do without them. It couldn’t be easier with Loperamide – read the instructions, remember the dosage, as for other tablets.BUT! Loperamide only relieves the symptoms of bowel disorders. Roughly speaking, you will stop “running”, but the infection that caused this desire will not go anywhere. If this misfortune is E. coli, then it needs to be treated. If the problem, after taking loperamide during the day, continues and does not disappear, you should not “sit” on loperamide, as this means that a full-fledged treatment is needed. Further reception can only aggravate the situation by the fact that the “infection” will cease to be excreted from the intestines in a natural way.


This is an antimicrobial agent (intestinal antiseptic), which is used for intestinal infections. It is with this that part of the “contagion” that causes diarrhea is treated. When treating with Nifuroxazide, you should not eat fresh vegetables and fruits, spicy and heavy foods for digestion, and drink juices. Careful reading of the instructions will give you a better understanding of how the drug works, its dosage and reception features. The first aid kit should be stocked for 3 days.


Antihistamine (antiallergic) drug.Allergies during a hike can show up in you, even if you have never had it before. A different climate, plants, food – all this can play a cruel joke, so to have an antiallergic drug costs . Loratadine is inexpensive and effective. The range of analogues in pharmacies is huge (including modern and expensive ones, including Desloratadine ).

If you have allergies that regularly appear, you better know which drug to take and put in your first aid kit for yourself.

Activated carbon

This is an absolutely necessary drug in a first-aid kit. It is cheap and simple, but very important for poisoning , flatulence, intestinal infections, etc. It is taken 1-1.5 hours before or after taking other drugs, otherwise it reduces their effectiveness. Dosage in different situations – in the instructions. Preparations of more modern forms have a similar effect, for example, sorbex or enterosgel capsules.


Validol is a simplified “heart pill”.Validol has a wide list of indications for use: attacks of mild angina pectoris (chest pain), sea and air sickness, etc. injury or stress. Be sure to read the instructions, follow the dosage and consult your doctor if you have heart problems.

Sometimes it is recommended to take nitroglycerin with your first aid kit .It is used if validol does not help, heart pains do not disappear, but in inexperienced hands, nitroglycerin is life-threatening .


Caffeine-sodium benzoate – stimulant of the central nervous system, enhances cardiac activity. A few tablets in the first aid kit are enough for hiking. It may be needed in case of an extreme situation, when it is necessary to keep a person conscious, to increase working capacity for a short time (for example, when exhaustion and the need for urgent transportation of a person to a medical facility).

Medicines for throat, cough

If he does not clear his throat – Ambroxol or Lasolvan . In the cold season, you can include other drugs (Strepsils, Decatilen, Trakhisan, Faringosept, Septefril, etc.) in the first-aid kit, and various throat lozenges. You may also need a spray or nasal drops.


If you are prone to manifestations of simple herpes , for example, after “freezing”, which can happen in a winter hike, or due to a decrease in immunity, it is worth taking an antiherpetic drug to your first aid kit on a hike.This can be acyclovir cream, ointment, or tablets. Tablets are more convenient to use, a cream or ointment can take effect faster, since they act locally. In any case, it is better to consult your doctor for the correct choice of dosage and form of the product.


Carefully include broad spectrum antibiotics in your travel kit. For example, Ciprofloxacin , which is often recommended in articles about first-aid kits on some sites, and mindlessly copied and pasted on others.For example, I deliberately do not take antibiotics on a hike, because I am not sure that I will be able to use them correctly. This is not Strepsils, which is worth sucking and will get better.

In my opinion, antibiotics can be included in the first-aid kit only for long hikes , or if there is a doctor in group who can weigh the pros and cons of prescribing a course. Why? For example, with inflammation of the middle ear (“blown out” during the hike), or pneumonia, one antibiotic tablet does not solve anything.The duration of the course in cases of diseases that can be tolerated on a tourist trip, on average, can be 3-5 days. And this is a regular intake several times a day! If you are traveling in isolation from civilization and do not have the ability to diagnose, antibiotics can only make it worse. In case of injuries threatening serious bacterial infection, it is better to immediately lower the victim to a medical facility.

Incorrect use of antibiotics or an incorrectly selected drug makes bacteria immune to this antibiotic and the benefits disappear.Plus, when an antibiotic kills bacteria (indiscriminately, including beneficial ones), a wide field opens up in the body for the reproduction of fungi, which they use. That is why doctors often “cover up” the appointment of antibiotics with antifungal therapy.

What else can you take?

Necessarily in the tourist first-aid kit you should put medicines for your individual diseases, chronic diseases that can be aggravated during the hike due to physical, emotional stress, or due to injuries.Or, increase the amount of standard medicines if you feel the need to. Think of seemingly non-standard remedies: for example, sunscreen should be put in a first aid kit for a hike.

The thermometer may have a trekking leader (or doctor) in the group first aid kit on long hikes, but it is not required for a short trekking first aid kit.

Tweezers will help to pull out a splinter or get rid of debris in a wound, pull out a sting after an insect bite.The simple tweezers found in every Victorinox knife and some multitool will also work.

Pincer Extraction Tool . In no case should you twist them with tweezers, just like with your hands. You can’t tear it off either! All these “methods” significantly increase the risk of catching borreliosis (Lyme disease) from the insides of the tick, which you yourself squeeze out of the insect into the wound. It is better to have a special (light and cheap) tool if you have not yet learned how to twist the pliers with a simple thread.For example this.

Rehydron is a powder for restoring salt balance in the body (restoring minerals, electrolytes that came out with sweat, vomiting, loose stools). This is a remedy that, in practice, will help to avoid seizures as a consequence of dehydration. For the same purpose, different isotonic (sports drinks) can be used.

It is often recommended to have hemostatic turnstile in the first-aid kit, which is an obligatory element of military equipment.However, among tourists, wearing turnstiles is not popular for several reasons: a good turnstile is not cheap, it takes up space, the likelihood of injury, which will require stopping serious bleeding from the military is much higher than from tourists. A classic tourist, unlike a military one, objectively does not want to wear a turnstile on a backpack strap or in another easily accessible place, given the minimal likelihood of its use.

However, if possible, turnstile should be included in a tourist first aid kit.At least for long hikes, activities associated with a significantly higher risk of limb injuries (open fractures, etc.) – mountaineering, freeriding, base jumping, swimming with bears, etc. The turnstile must be of high quality and reliable – beware cheap imitations.

Let me remind you that when applying a bundle, its width plays an important role. The smaller its area, which presses the vessels, the faster tissue death will occur. Therefore, paracord or other ropes are not suitable for pinching vessels , and all normal turnstiles have a wide sling.In this matter, you should foresee your actions in advance, because there will be no time to think with a hole in the artery.

Hemostatic bandage is not a cheap thing, but it helps a lot with serious open injuries. For simple hiking trips, this may be redundant, but for mountaineering ascents, other extreme activities where there is a high risk of injury, a hemostatic agent may be included in a tourist’s first-aid kit.

A separate sheet with a description of the contents of the first-aid kit , drugs, their dosage and how to use each will not be superfluous.This is in case another person has to use it, or in a panic you forget everything you read about in the instructions for the pills.

You can include in the first-aid kit for a hike also alcohol (permanent) marker , which in case of an emergency, write on the victim’s forehead the time of the tourniquet application, the dosage and time of the drugs administered to him and other important information. This will be very useful for doctors in a medical facility if the victim has to be transported there.

Complete set of tourist’s first aid kit

Below is a list of a tourist’s first aid kit of medicines and medical supplies, with which you can safely go to the pharmacy. Most of the items (especially tablets) have numerous analogues with the same active ingredient and are sold under different brand names. Often, the packaging of a certain drug is trite more convenient for a travel first-aid kit, and you don’t always need to buy a whole pack of pills – a plate may be enough. What should be in a first aid kit:

  • Elastic bandage
  • Non-sterile bandage
  • Patch in roll (2 cm)
  • Bactericidal plaster
  • Atraumatic scissors
  • Alcohol wipes
  • Gauze wipes, cotton swabs
  • Nitrile gloves (palm-sized)
  • Pincer Extraction Tool
  • Tweezers
  • Safety pin
  • Hydrogen peroxide
  • Chlorhexidine
  • Ammonia solution (ammonia)
  • Ketorolac or Dexketoprofen
  • Paracetamol
  • Ibuprofen
  • Omeprazole (Pantoprazole)
  • Diclofenac sodium (gel)
  • Spazmalgon
  • Loperamide
  • Nifuroxazide
  • Loratadine
  • Sorbex (activated carbon)
  • Validol
  • Caffeine-sodium benzoate
  • Ambroxol or Lazolvan
  • Decatilen or Trachisan or Faringosept
  • Rehydron

General recommendations and life hacks

  1. Check the expiration date of the preparations in the travel medicine cabinet before the hike.Expired medicines cannot be used.
  2. It is not always necessary to take a whole plate of tablets – it is enough to cut off the required amount from the blister , write the expiration date on it with a marker, and duplicate the name if it does not fit completely.
  3. The reverse side of the plate of tablets can be sealed with tape or a plaster – this will protect the tablets from breaking the package.
  4. The tourist’s first-aid kit is completed depending on the conditions of the trip and its duration.It is not always advisable to carry a complete set of medicines with you. You can also divide drugs and funds into separate packages – emergency availability and what is not urgently needed and can be carried deep in a backpack.
  5. If the adhesive does not adhere well, you can cover it on top with gray reinforced tape (Duct Tape). But choose good quality tape. Also, if you are prone to dropsy and chafing, such adhesive tape can seal potentially “dangerous” areas of the skin even before the start of the day’s transition.Be sure to shoot at night!
  6. If you need to take certain tablets on a regular basis, put them in the special pressurized medicine container . They look like a miniature keychain capsule that cannot be broken. It is convenient: the tablets will not get wet and will always be at hand.
  7. For winter hikes , the first aid kit is different : allergies are less likely, frostbite is more likely, you will also need lip balm, and hydrogen peroxide will freeze.There will also be different first-aid kit for freeriding, first-aid kit for a climber, first-aid kit for the sea, etc.
  8. Remember to get diphtheria and tetanus shots every 10 years.

Everything that you have collected for a first-aid kit, of course, needs to be worn in something. The best and most convenient option is to buy a travel first aid kit, designed and made especially for hiking. They are already filled with the necessary medicines and other useful things, or empty (only a cover).You can put anything in the empty one, but the already filled one has its plus in the fact that good manufacturers complete them with high-quality bandages, plasters, scissors and other foreign-made medicines. They are mostly of better quality than those that can be found cheaply in our pharmacies, so buying a filled first aid kit can win on this.

As for me, the most comfortable and sophisticated travel first aid kits are produced by Tatonka, Deuter and Lifesystems. Also, for the first-aid kit, you can use plastic sealed containers, sealed bags or other similar covers or handbags.Finally, you can sew the medication pouch yourself.


The information presented in this article is for informational purposes only, is not an instruction for action , it is presented solely for information and understanding of the need for a more detailed study of certain issues. All information is provided without guarantees of completeness, accuracy and modernity and without other express or implied warranties. The use of the information provided is at your sole discretion and risk.The author is not responsible for any correct or incorrect use of the information provided, including those that caused harm to health. Remember that self-medication can be harmful to your health and life-threatening. The best solution is to include a professional doctor in your first aid kit. 🙂

Oleksandr Omelchenko for TopRope.com.ua, 2019.
Full or partial reproduction of material without permission of the author is prohibited!

Shiro vyachny for advice on preparation of material to the instructor of tactical medicine of the state institution “Zakhist Patriot” Nazarov Melnychuk , instructor of tactful medicine Roman Sviridyuk Tactical medicineThe text is updated.

Squaring the circle | Gerasimov | Clinical and experimental thyroidology

The idea for this column came to my mind during my last year’s trip to the republics of the Transcaucasus. During 2016, the Global Iodine Network (GID), together with UNICEF and national partners, conducted a study of the iodine supply of the population of Georgia, Abkhazia and Armenia. Historically, these regions of Transcaucasia are known for the widespread prevalence of endemic goiter due to the low iodine content in the soil and drinking water: there, many rivers are fed by the melting of mountain glaciers and the water in them is almost distilled.But over the past 15–20 years, laws and regulations have been passed in Georgia and Armenia on the mandatory iodization of salt, which is now used in their kitchens by almost 100% of families, restaurants, canteens and almost the entire food industry. All this led to an adequate iodine supply of the population, confirmed by reliable epidemiological surveys conducted back in 2005–2006. [12].

However, speaking with practitioners, I was surprised to learn that they still find numerous cases of diffuse goiter and are actively prescribing iodine supplements for children, adolescents and pregnant women.The doctors, of course, knew about iodized salt, but, to put it delicately, they expressed vague doubts about its effectiveness as a universal prophylactic agent. And one respected colleague expressed himself on this matter in the spirit of a classic: “I don’t believe!” 1 [1].

Let’s be frank – not everyone on whom the success in eliminating iodine deficiency diseases in and around Russia depends is convinced of the effectiveness of the program of mass, mandatory iodized salt. Some tend to look for “alternative” solutions.But it so happened that an “experiment” was unwittingly carried out in Transcaucasia, which once again proved the high efficiency of the programs for the mass iodization of salt. Let’s compare the situation in Georgia and Abkhazia.

According to a survey conducted in Abkhazia in 2016, the results of which were published on the pages of this journal [3], the median concentration of iodine in urine was 29 μg / L in children 8–12 years old and 26 μg / L in pregnant women. That is, literally a couple of steps remained to the border of severe iodine deficiency (less than 20 μg / l).

But according to a yet unpublished study conducted in Georgia in the same 2016, the median concentration of iodine was an order of magnitude (this means 10 times) more: 293 μg / L in schoolchildren and 249 μg / L in pregnant women2 [2]. What is the reason for the differences? The fact that in Abkhazia residents practically do not use iodized salt (although, in principle, it can be bought in supermarkets): when testing salt collected from households, only 1% of the samples contained iodine. On the other side of the Inguri River, in Georgia, on the contrary, almost 100% of salt samples from households were fortified with iodine.In addition, iodized salt is used in bakery, food processing (for example, in the manufacture of cheeses), as well as in public catering. And this did not happen yesterday, but 10-15 years ago, as laws and regulations were adopted and implemented to ban the import of non-iodized salt into the country (Georgia does not produce its own salt).

Honestly, I did not expect such a stunning difference between two geographically similar territories, which not so long ago were a single Soviet republic.

But if there can be such differences in the supply of iodine to the population, then another interesting question arises: how much should the approaches to the diagnosis and treatment of thyroid pathology differ between countries / regions in which iodine deficiency has been successfully eliminated by universal salt iodization, and those places where iodine deficiency remains of varying severity?

This is not an idle question, since monographs, articles and recommendations on the diagnosis, treatment and prevention of thyroid diseases, written in Russia for the situation of persisting iodine deficiency, are read both north and south of the Greater Caucasus Range, which is a kind of watershed between territories where the population consumes with food either insufficient or quite appropriate amount of iodine.The same border lies in the west with Belarus and in the southeast with Kazakhstan.

This idea can be continued in the following vein: how should the diagnostic and therapeutic tactics in relation to thyroid diseases be changed during the introduction of the universal salt iodization program in the country? I am still not tired of hoping that this will happen in Russia. I would like, of course, to do it as soon as possible.

If we recall the relatively recent past, at the end of the 1960s in the USSR, the frequency of endemic goiter, according to official data, decreased to a sporadic level, new cases of cretinism and large goiter disappeared.This happened due to the massive use of iodized salt, the production of which by that time had reached a million tons per year (more than 4 kg per capita). Not surprisingly, endemic goiter was gradually forgotten, and in the endocrinology textbook, which we taught this discipline in the 1980s, only a couple of pages were devoted to this topic.

But, apparently, the iodine deficiency in the diet of the population of the USSR in the second half of the twentieth century was not completely eliminated and not everywhere.Moreover, as economic difficulties grew, the production of iodized salt in the USSR in the 1980s began to decline, and its quality remained low: in more than half of the salt samples, the iodine content was below the prescribed standard.

But since the endemic goiter in the country no longer existed, new cases of diffuse goiter began to be called “thyroid hyperplasia”, and autoimmune thyroiditis (AIT) was decided to be the cause of this phenomenon. After the actual cessation of the production of iodized salt in 1991–92.the number of cases of “hyperplasia” in children and adolescents began to grow sharply. Then the reason for the increase in the frequency of goiter was already associated with the effect of “radiation” after the accident at the Chernobyl nuclear power plant. The more prosaic reason – the presence of iodine deficiency in the diet – has already been firmly forgotten. The analysis of myths in Russian thyroidology was the subject of our joint work with G.A. Melnichenko and V.V. Fadeev article published in 2001 [4] and had a wide response. It can be easily found on the Internet even now.

One way or another, but over a dozen years, the myth of the total defeat of the population of AIT was difficult to cope with, and information about the widespread occurrence of endemic goiter gradually reached the wide masses of practical doctors.New diagnostic and treatment algorithms were adopted, and iodine supplements became a top-selling OTC and dietary supplement.

And now we are facing a new cultural revolution in thyroidology? As the hero of the popular Soviet television series used to say, “let’s not be nervous and we’ll sort it out calmly”. We are not in danger of any tectonic shifts in the established approaches to the diagnosis and treatment of thyroid pathology, but certain adjustments will certainly be required in them.But the massive use of iodine supplements will gradually have to be abandoned. That’s for sure.

The relationship between the amount of iodine consumption and the incidence of thyroid pathology is not linear. Rather, this curve resembles the letter U of the Latin alphabet (U-shaped). Both low and excessively high intake of iodine disrupts thyroid function and increases the incidence of thyroid disease.

In case of insufficient intake of iodine, the function of the thyroid gland is maintained by accelerating the turnover of iodine in the body.Iodine deficiency stimulates the secretion of thyroid-stimulating hormone (TSH), increases the expression of sodium iodine symporter to maximize the uptake of iodine by thyrocytes and its more efficient reuse after the breakdown of thyroid hormones, and also reduces the excretion of iodine by the kidneys. In regions with mild and moderate iodine deficiency in residents, as a rule, there is an increase in the concentration of thyroglobulin in the blood and an increase in the volume of the thyroid gland. As for the level of TSH, it rather tends to decrease (especially in people over 60 years old) due to an increase in the frequency of nodular toxic goiter.If iodine deficiency in the diet shifts towards severe, then the level of TSH in the blood begins to gradually increase, often with the development of subclinical hypothyroidism. The concentration of T4 in the blood decreases, and T3 – increases, since the biological efficiency of T3 is about 4 times higher than T4, while its synthesis requires 25% less iodine [5].

Thus, with the correction of iodine deficiency against the background of the massive use of iodized salt, one can first expect a decrease in the incidence and prevalence of diffuse (endemic) goiter in all age groups.But you should not expect an instant result; it will take several years. For example, in Belarus, after the adoption of a government decree on the mandatory use of iodized salt in the food industry, the primary incidence of diffuse goiter in adults in the period from 1998 to 2012 decreased almost 12 times, and in children and adolescents – almost 3 times [6]. In addition, in persons under 50 years of age, one can expect a decrease in the incidence of thyroid nodules, while in older age groups and due to fibrotic changes in the nodes, their reverse development is impossible [5].

The classic, we can already say, the work of Peter Lauberg and his group [7] showed that the risk of developing hyperthyroidism during life in residents of areas of Denmark who had iodine deficiency (median iodine concentration – 40–70 μg / l) was 2 , 3 times higher than among Icelanders, whose dietary iodine intake was increased (400–450 μg / l). It should be borne in mind that the Icelanders are the descendants of the Vikings from Denmark, who moved to the island hundreds of years ago. At the same time, in Danish descendants of Vikings, the most common cause of hyperthyroidism was multinodular toxic goiter in persons over 50 years old, and in Icelandic descendants – Graves’ disease in islanders younger than 50 years old.Apparently, iodine deficiency increases the risk of developing multinodular toxic goiter, stimulating proliferation and mutagenesis, which lead to the appearance of clusters of autonomous thyrocytes.

Thus, in the long term, against the background of normalization of iodine consumption, the frequency of hyperthyroidism among people over 50 should decrease. This can be regarded as a very positive trend, since the diagnosis and treatment of multinodular toxic goiter in the elderly seriously increase the burden on the health care system and require relatively large financial costs.In addition, reducing the incidence of thyrotoxicosis as a cause of atrial fibrillation can reduce mortality in citizens over 65 years of age [8].

However, the path to this goal will not be smooth: at the initial stage of the salt iodization program, on the contrary, an increase in the incidence of hyperthyroidism can be expected in patients over 60 years of age with nodular goiter. This is due to the fact that thyrocytes in the tissue of the nodes lose sensitivity to TSH and, with a sharp increase in iodine consumption, are capable of hyperproduction of thyroid hormones.

In the early 1990s, in some African countries (Zaire, Zimbabwe, Congo, etc.), whose population had a severe iodine deficiency, began the production of iodized salt with a fairly high iodine content (80-100 mg / kg). We thought that in hot and humid climates the loss of iodine from salt would be very large, and they decided to compensate for them by adding more potassium iodate to it. But it turned out that the preservation of potassium iodate in salt is much higher than previously expected, even against the background of an unfavorable climate and a high proportion of impurities in salt.The salt iodization program was soon adjusted, but the sediment, as they say, remained. This unfortunate example is often appealed to by the manufacturers of “organic” iodine supplements, which allegedly lack this disadvantage. This is a lie. Iodine-induced thyrotoxicosis can occur when a large amount of iodine enters the body in both organic and inorganic compounds.

In countries with mild to moderate iodine deficiency, with proper salt iodization programs, an increase in the incidence of hyperthyroidism may also occur.But this increase is of a transient nature, partly due to the cure of patients with hyperthyroidism, but mainly due to a decrease in the risk of developing new cases of nodular goiter and thyroid autonomy against the background of optimizing iodine intake, which we have already mentioned above. As for Graves’ disease, according to most studies, its incidence does not increase against the background of normalization of dietary iodine intake [5].

Therefore, when introducing salt iodization programs, every effort should be made to prevent excess iodine in the diet.The standard for the iodine content in salt established by the Russian GOST (40 ± 15 mg / kg) should, according to calculations, ensure optimal iodine intake. At least, this is indicated by the experience of Belarus and Kazakhstan, whose population, when using salt with the same iodine content as in Russia, has a median concentration of iodine in urine within the normal range.

But iodine enters the human body, of course, not only with iodized salt. For example, in Iceland and Japan, iodine consumption is several times higher than the recommended standards due to the traditional addiction of residents to fish, seafood or seaweed (kelp).Another reason for excess iodine is drinking water, which, due to the geochemical characteristics of the soil, can have an increased iodine content. Such a situation was encountered, for example, in some regions of China. In Russia, we still know a single case of chronic excess consumption of iodine by the population of the city of Turinsk, Sverdlovsk region [9].

Colleagues from Yekaterinburg first encountered this phenomenon when studying the state of iodine supply in the population of the Sverdlovsk region.The iodine content in the urine of children from Turinsk in the literal sense of the word went off scale, and for the analysis of iodine, repeated dilutions of urine had to be done. Later it was found that the maximum permissible concentration (MPC) of iodine in the city’s tap water exceeds the permitted one by 4–5 times. The reason for the contamination of drinking water turned out to be a hot mineral spring, popular among the people, located upstream of the Tura, whose waters flowed into the river. The study showed that the concentration of iodine in tap water in Turinsk averaged 629 μg / L.At the same time, in houses that were supplied with water from artesian wells, the iodine content was 100 times less.

The median concentration of iodine in urine in 97 children in Turinsk (719 μg / l) was about 6 times higher than in the control group of 100 children in the city of Pervouralsk – 120.8 μg / l. In all urine samples collected in Turinsk, the iodine concentration exceeded 100 μg / L, in 36% of the samples it was more than 1000 μg / L, and in 6% – above 2000 μg / L. In children from Turinsk, significantly higher average values ​​of the TSH level were established, and a single case of subclinical hypothyroidism with a TSH level of 9.2 mIU / L was also recorded.The frequency of diffuse enlargement of the thyroid gland according to ultrasound data in children in Turinsk was 32% and was significantly higher than in Pervouralsk – 14.4%.

Indicators of thyroid function and the spectrum of thyroid pathology in the adult population of the cities of Turinsk and Pervouralsk, Sverdlovsk region. Modified from [9]





Number of examined, M / F

100 (18M / 82ZH)

100 (23M / 77ZH)

> 0.05

Average age, years



> 0.05

Average concentration of TSH in blood, mU / l




Frequency of subclinical hypothyroidism




Frequency of overt hypothyroidism



> 0.05

Frequency of subclinical hyperthyroidism


> 0.05

Frequency of autoimmune thyroiditis




In adult volunteers from Turinsk, compared with subjects from Pervouralsk, a significant increase in the average level of TSH, as well as the frequency of subclinical hypothyroidism and AIT was found (table).The criteria for the diagnosis of AIT in this study were the level of antibodies to thyroperoxidase more than 36 mIU / L and the presence of subclinical or overt hypothyroidism. The groups of adults did not differ significantly in terms of the volume of the thyroid gland and the prevalence of nodules.

For what purposes have I devoted so much of my column to a retelling of a relatively recently published article? The fact is that popular rumor stubbornly does not see the difference between the consequences of a really excessive and optimal consumption of iodine with food.The domestic article is good because, in principle, it confirms the previously known data that a significant increase in iodine consumption can stimulate autoimmune processes in the thyroid gland, possibly by increasing the antigenic properties of thyroglobulin, and increase the frequency of hypothyroidism, mostly subclinical.

But let’s agree: no one in Russia is going to iodize table salt in such a way as to achieve the indicators of the city of Turinsk, the country’s champion in the excretion of iodine with urine3 [3].We are talking about achieving the optimal value at which the median concentration of iodine in the urine in children will be in the range from 100 to 300 μg / l, and in pregnant women – from 150 to 250 μg / l.

According to numerous studies, at the initial stage of the implementation of the salt iodization program, a slight increase in the frequency of carriage of antibodies (usually a low titer) is possible. It is not yet clear whether this carrier will be permanent or temporary. In any case, with optimal iodine intake, one should not expect any significant increase in the prevalence of AIT in the population [5].

If the return of the great and terrible AIT against the background of mass iodization of the salt of Russia still, I hope, does not threaten us, then I do not have such firm confidence in the prospects for the emergence of a possible “epidemic” of subclinical hyperthyroidism. According to a prospective 5-year study in China [10], which compared population cohorts with insufficient, optimal and increased iodine intake, the cumulative incidence of overt hypothyroidism did not significantly differ between groups (0.2, 0.5 and 0.3%) …However, there was a significant increase in the incidence of subclinical hypothyroidism with optimal and excess iodine intake (0.2, 2.6 and 2.9%). Thus, against the background of the normalization of iodine consumption in Russia, one can expect some increase in the frequency of moderate subclinical hypothyroidism, which does not require active therapeutic intervention.

But in real life, you have to prepare for the worst. According to a recently published article in the Lancet Diabetes Endocrinology [11], the number of prescriptions for L-thyroxine from 2007 to 2014 wasin the United States grew from 100 to 120 million units per year and became the most popular prescription drug in the country. In the UK, the relative growth was even greater (from 20 to almost 30 million prescriptions), with L-thyroxine coming in third in popularity. At the same time, the United States belongs to the countries with optimal iodine consumption, and in the UK even moderate iodine deficiency remains. So, there is no connection between the consumption of iodine and the increase in cases of hypothyroidism, for which L-thyroxine has been prescribed in many cases? Alas, the search for an answer to this question can lead us beyond the rational.

The prevalence of hypothyroidism is influenced by natural processes, which include the amount of iodine intake, as well as the aging of the population: it is known that the incidence of hypothyroidism increases with age. But besides natural, there are, I’m not afraid to say, unnatural processes, the nature of which is much more obscure. These include, for example, the adoption in the last decade by a number of medical associations of recommendations for screening every 5 years for TSH in men and women over 35 years old who do not have any clinical manifestations of thyroid disorders.After that, the increase in cases of laboratory hypothyroidism was not long in coming. Or the adoption, without sufficient scientific justification, of yet another recommendation for the treatment of L-thyroxine in patients with slightly increased TSH levels and complaints for which hypothyroidism can be suspected. Despite the fact that in 60% of cases a slightly elevated TSH level is normalized without any treatment, it has become a practice to prescribe L-thyroxine in “small doses” even with a single increase in TSH.

Or maybe the ancient Greek philosopher Aristotle was right when he first noticed that nature abhors a vacuum? And the place of disappearing cases of diffuse goiter, which should have been “observed”, measured with an ultrasound sensor and carefully “treated” with iodine supplements, will be taken by subclinical hypothyroidism or microscopic thyroid “carcinomas”, which require even more time and effort of aesculapius? The search for an answer to this question is more difficult than solving the problem of squaring the circle4 [4].

Additional information

Conflict of interest . The author declares the absence of obvious and potential conflicts of interest related to the publication of this article.

[1] “I don’t believe!” – a phrase that has become legendary in the world of cinema, theater and in the household sphere, after K.S. Stanislavsky.

[2] Data provided by the National Center for Disease Control and Public Health of Georgia.

[3] Despite the fact that the data on multiple excess of the MPC of iodine in the tap water in Turinsk were brought to the attention of the federal and regional authorities, no measures have been taken to prevent its contamination with iodine.

[4] The futility of research on squaring the circle has changed the meaning of this phrase, which now simply denotes a hopeless, meaningless, or futile enterprise (from Wikipedia).