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- Oct 29, 2021
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The Hypoxia Hurt Game
Your head hurts, you’re slightly nauseous, each step you take injects pain into every cell of your body, and you have a hard time wrangling the motivation to eat. Hungover? No. Just climbing at elevation. Welcome to the hypoxia hurt game.
As mountain athletes, the elevations that we play in affect our bodies and minds in many ways. If you’re like us, you want get the most out of your time trekking or climbing in the mountains, it’s important to understand the physiological changes that your body is enduring at elevation, and how they manifest for you.
How well you do at high altitudes depends on many variables to be sure. You can train for months in advance of your trip and be in the best shape of your life, but if you ignore the potential impacts of high altitude illness your hard work may all be for naught. Preparing for a high altitude trek or climb includes training, getting the essential equipment, some mental work, and understanding what your nutritional needs will be. But, the first and foremost way to prevent illness up high on your climb is knowledge.
How high is high?
Altitudes over 9,000 feet (2,743 M) are considered high. This means whether you are on Mount Baker, Kilimanjaro, or Aconcagua, you will be impacted no matter who you are and how well you do up high. As elevation increases, atmospheric pressure decreases. Lower pressure allows the oxygen molecules in air to spread out. This means that each of your inhalations at altitude contain fewer oxygen molecules. At the top of Everest (29,035 ft / 8848 M) the partial pressure of oxygen is one-third that of sea-level. If you were magically deposited at the top of Everest without prior acclimatization you would lose consciousness within minutes and you would die.
![17 April17 Icefall3 FB](https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1833&q=80&w=2200&s=d25d29337e2a305949e55ec3f07b897a 2200w 1833h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1667&q=80&w=2000&s=a0d58ff68925dba58ddc25569251fcbf 2000w 1667h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1500&q=80&w=1800&s=c292177b13b66534ab8efe0283a96bc7 1800w 1500h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1333&q=80&w=1600&s=546106973bbce6cbf0c60e86927e07cd 1600w 1333h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1167&q=80&w=1400&s=9cca4e4711798bb38cb1e77d0f288d40 1400w 1167h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=1000&q=80&w=1200&s=2d532481f5d7d982eeb12c7ebb389adf 1200w 1000h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=833&q=80&w=1000&s=c9ca6adad44007be2888f72b509ca754 1000w 833h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=667&q=80&w=800&s=382928aa2330b3671b2c8f804a62a431 800w 667h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=500&q=80&w=600&s=d9548329693920ca8d9092c9580b7e4c 600w 500h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=333&q=80&w=400&s=dc35653dea6c83081cc882278ad5da91 400w 333h, https://mountain-madness.imgix.net/general-images/17April17_Icefall3_FB.f1635543787.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5227&fp-y=0.5877&h=167&q=80&w=200&s=bd83936df3c2c0d010888a5998ebed9f 200w 167h)
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Adaptation
There soon becomes a lot of activity in your body as you arrive at higher altitudes. The first reaction is your body acclimates to lower pressure and less oxygen with both acute and longer-term changes. Initially, your body, wondering where all the oxygen has gone, responds by increasing your respiratory and heart rates to increase oxygen delivery to tissues. Then, your kidneys start producing bicarbonate and increasing urine production to keep your pH neutral. After a couple of days at a new elevation your heart and respiratory rates start to slow down as your pH returns closer to normal. Your body also responds by increasing a hormone called erythropoietin which in turn increases the production of oxygen-carrying red blood cells. Increased erythropoietin production starts within minutes of arriving at high altitude but takes 2 – 3 weeks to complete.
How to prevent illness
If you’ve ever rushed the acclimatization process, like a two-day ascent of Mount Rainier, or driven to the top of Pike’s Peak, you’re familiar with the headache that marks the onset of Acute Mountain Sickness (AMS). Other altitude-related illness such as High Altitude Pulmonary Edema (HAPE), High Altitude Cerebral Edema (HACE) and High-Altitude Flatulence Expulsions (HAFE) can also occur; the former two can be deadly, while the latter only threatens the welfare of your tent mate and lead you to end up sleeping outside. These risks can be minimized by following a proper acclimatization strategy, changing dietary habits, and in some cases by using medications.
If you are coming from lower elevations, or even sea level, those aren’t points against you in the game of high altitude mountaineering or trekking, it’s just something that needs to be strategically handled with each new elevation reached. You don’t need the centuries old genetic adaptations to altitude of a Sherpa or the Andean Quechua, just some basic things will go a long ways in helping you reach your goal.
![Cho Oyu summit climb with Mountain Madness](https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1833&q=80&w=2200&s=918627b78dbe3cac8c365428cec9d8ce 2200w 1833h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1667&q=80&w=2000&s=0b970c6c3e6ebaa83b6e7c70e2fa517c 2000w 1667h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1500&q=80&w=1800&s=af4ae6e0c53ecc972e7ae1b47d96a645 1800w 1500h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1333&q=80&w=1600&s=69b2310524e783e3c1f302c2588a05c7 1600w 1333h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1167&q=80&w=1400&s=86098bce2c2527898f86e234035073ee 1400w 1167h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1000&q=80&w=1200&s=60efd7af05d107f2da62e9b1d4d2e3b4 1200w 1000h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=833&q=80&w=1000&s=eb9907adce050d1cfd991f7569926df8 1000w 833h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=667&q=80&w=800&s=2875ae68e99a9be8676364d2ca514cfc 800w 667h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=500&q=80&w=600&s=34a3b220d49c3f32bd07d338a772af60 600w 500h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=333&q=80&w=400&s=0a5418b9cf6c1949eb86ed2ac5bbb782 400w 333h, https://mountain-madness.imgix.net/general-images/i-WvLCt2w-X3.f1635725040.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=167&q=80&w=200&s=ce8e8c0d1bf999af67ce672aa631e7a4 200w 167h)
![Kili Summit Oct2010](https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1833&q=80&w=2200&s=1cfe72fdec311d3584f7e6c08b29d81c 2200w 1833h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1667&q=80&w=2000&s=d86d3119eabc727e410d79268435d3a3 2000w 1667h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1500&q=80&w=1800&s=e51e539b054152b378abbda2d6ab6431 1800w 1500h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1333&q=80&w=1600&s=a9f2e8d1028eb4c9ba4b88d41bad3bd4 1600w 1333h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1167&q=80&w=1400&s=fe4fc0aab0aaf52a0459ff114ec7841f 1400w 1167h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1000&q=80&w=1200&s=b64591df0f85040e8e8eb02206350889 1200w 1000h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=833&q=80&w=1000&s=a2315c143e51652fe9bf5d7c31d88033 1000w 833h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=667&q=80&w=800&s=441902a3bcd710ea19155ae4685cd683 800w 667h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=500&q=80&w=600&s=2725d6795551e881e72e13b778088352 600w 500h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=333&q=80&w=400&s=96e56066a608f8b5eadd84e62dd3a053 400w 333h, https://mountain-madness.imgix.net/general-images/Kili_Summit_Oct2010_2021-10-31-235857_xnvy.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=167&q=80&w=200&s=adc0607b1953c638b1c5ebd261f1cbe5 200w 167h)
![western breach on Kilimanjaro on the way to the summit](https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1833&q=80&w=2200&s=a6b420b99a140aa8f9ffdebe12ad203b 2200w 1833h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1667&q=80&w=2000&s=788cae45f868259eb015c0d1ae64b885 2000w 1667h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1500&q=80&w=1800&s=dab54438676af5feb0faf370008cc890 1800w 1500h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1333&q=80&w=1600&s=55d29de5953735ad173e86041400874b 1600w 1333h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1167&q=80&w=1400&s=399653a6d91313ba36972bffe4d5bacc 1400w 1167h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=1000&q=80&w=1200&s=d138b275a2b6ff63bee834d1f103b0e9 1200w 1000h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=833&q=80&w=1000&s=7f20ef49f9c635a54847b84b294a5dbb 1000w 833h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=667&q=80&w=800&s=0aaab03a1d447d371af44e0712e7d9ea 800w 667h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=500&q=80&w=600&s=d37ef68f4ec01c0097415acfaf28c3cb 600w 500h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=333&q=80&w=400&s=98ad0263c36ecaeb9b4acee3248091c2 400w 333h, https://mountain-madness.imgix.net/general-images/Tanzania-356.f1635725569.jpg?auto=compress%2Cformat&crop=focalpoint&fit=crop&fp-x=0.5&fp-y=0.5&h=167&q=80&w=200&s=4c7f54988b1fa21309462db4f1bcc3e6 200w 167h)
As mountain athletes who endeavor to climb high and feel as strong as possible, the best way to work with the changes that altitude causes is to acclimatize. Practically, this means ascending to a new high point then returning the same day to sleep at a lower elevation. This climb high, sleep low approach allows your body to slowly adapt to the stress of performing in an oxygen deprived environment.
So, what’s a mountain athlete to do?
- If you’re joining a Mountain Madness trip, please read the section of high altitude illness in your departure info we send you; otherwise,
- Plan acclimatization into your schedule
- Reduce as much stress on your body as possible. Stay hydrated, rest, eat well
- Communicate how you’re feeling to your guide or teammates
- Listen to your body — there are times when you have to push through the hurt and others when it’s better to take a time out; it’s ok to take a break now and then
Some solid resources
Training by yourself or with a partner is fine, get a program dialed and stick to it. But, if you hire a trainer it’s worth considering finding someone that has some knowledge of high altitude climbing and trekking and what your body goes through. Alpine Athletics owner Lisa Thompson, who has climbed the Seven Summits and K2, has programs that train you, gives you advice on equipment and nutrition, and that provide invaluable insights from someone that has played the hurt game and overcame the challenges of high altitude.
A couple of go to books to get you schooled and intrigued at the same time include Going Higher and Training for the New Alpinism.
Contributors: Dr. Tracee Metcalfe, Lisa Thompson/Alpine Athletics, and Mark Gunlogson