Peggie Zih, my friend and colleague from Hong Kong, has generously shared her expertise and knowledge of herbs and Chinese Medicine combined with her experience at high altitudes for the benefit of those of us who live in and hike at high altitudes here in the Rocky Mountains. I hope you enjoy. – Tracey
Trekking high altitudes had never appeared in my travel plans until I joined a friend’s tour to Tibet in 2013. I went on few more highland trips after that first experience. Starting with the first trip, I started researching and experimenting with natural protocols for traveling to highlands. I also shared my herbal protocol with friends going to highlands. All experiences helped me in understanding the wisdom of our bodies and herbs.
Two Facts about High Altitudes
High altitudes range from 2500m [8,202 ft.] to over 8000m [26,247 ft.]. The height of the base camp at Mount Everest is 5600m [18,373 ft.], and anything beyond that requires tremendous preparation, mentally and physically. Two facts about high altitudes:
- The temperature goes down by 6°C [10.8°F] for every 1000m [3,281ft.] elevation in altitude. That means temperatures at high altitudes can get chilly. It increases one’s susceptibility to cold.
- The concentration of oxygen decreases with reduced air pressure at high altitudes. At 4000m [13,123 ft.], the oxygen level drops to 61% of that at sea level. Oxygen is vital to keep us alive, and the optimal utilization of oxygen becomes critical at high altitudes.
Symptoms of Acute Mountain Sickness
High altitude sickness can take multiple forms – the High Altitude Cerebral edema (HACE) and the more sever form High Altitude Pulmonary Edema (HAPE). Acute Mountain Sickness (AMS) describes symptoms experienced by most people trekking to altitudes above 2500m [8,202 ft.] Symptoms can be a combination of headaches, fatigue, irritability, nausea, vomiting, loss of appetite, indigestion, flatulence, sleep disturbance, and general weakness. Individuals may start to feel the symptoms minutes or hours after exposure to high altitudes. Symptoms may subside upon full acclimatization.
How We Acclimatize
When the concentration of oxygen drops at high altitudes, our bodies do three things to help with the adaptation:
- Hyperventilation to increase the ventilation rate to get more oxygen
- Increasing the heart rate to compensate for the slower diffusion of oxygen in the arterial blood
- Increasing the hemoglobin (responsible for transporting oxygen to the needed organs/functions) through increased erythropoietin (EPO) secretion in the kidneys to ramp up hemoglobin.
The first two steps are an immediate response, while the last step takes hours to days. This is the reason why gradually ascending and sleeping at a lower altitude are powerful tools to help you acclimatize. It allows the body to get into the mode of increasing oxygen-carrying capacity to support acclimatization.
Know Your Weakest Link
Different people will experience various altitude sickness symptoms, and most of those symptoms will reveal your weakest physiological link.
• Cardiovascular health challenges such as high blood pressure will often bring on headaches
• Indigestion (leaky gut, abdominal bloating, constipation) can often bring on nausea and / or aggravated digestive challenges
• Circulation challenges, including inefficient lymphatic circulation, will often bring on edema
• Respiratory health challenges such as asthma or COPD (Chronic Obstructive Pulmonary Disease) will often create shortness of breath upon altitudes beyond 2000m [6,562 ft.]
It can even be insomnia that you have become used to that could cause you undesirable consequences at high altitudes. Spending some time strengthening your weakest link before your journey will enable your body to acclimatize to high altitudes easier.
The better and quicker you acclimatize, the shorter the duration will be in the stage of discomfort. One can support the acclimatization experience through preparation before the trip and during the trip.
Two to four weeks before your high altitude trip, it is crucial to prepare the body to:
- Improve the body’s resistance to stress – High altitudes with less oxygen is stressful to the body. When we improve the body’s resistance, we can increase its threshold for challenges. Another necessary preparation is to reduce your stress level before your trip. Imagine what it would be like if you are at your threshold of stress before you start your journey. The high altitude environment will be an immediate trigger as your body is already overloaded
- Improve circulation – Improving oxygen-carrying capacity and circulation will support efficient delivery and use of vital nutrients needed by various systems.
- Improve digestion – Digestion is the process to break down food into vital nutrients. The more sluggish this process is, the fewer nutrients will be available, and the harder your circulation will have to work to get the nutrients needed.
During the Ascent
Supporting acclimatization during your first few days of trekking high altitudes is crucial and involves:
- Supporting efficient digestion – When our system is starved of oxygenated blood, maximizing the digestion to provide the best nutrients without taxing the system is key. Hydration and simple-to-digest nutritious food should be the foundation. Eating to 70% full will support the energy needed and will divert resources to circulation and maintaining vital body functions.
- Keeping warm and supporting circulation to reduce the stress load on the body. Avoid over-stimulation of the circulation by staying away from alcohol and keeping hydrated.
- Enhancing adaptation with a good balance of sleep or rest and activity and the use of herbs that are adaptogens and qi tonics.
- Preparing oxygen supply for emergency – Oxygen bottles are readily available when you arrive at highlands. This provides an immediate supply of oxygen and can help to alleviate symptoms when you feel that you need more support for the acclimatization.
Additional tools that I find handy during the acclimatization:
- Fresh ginger will reduce digestive symptoms. Drinking a decoction of ginger with brown sugar [boiling these for about 10 minutes] can keep the body warm. This will be particularly helpful if you experienced snow or rain at highlands. Finally, nauseous people can benefit significantly by simply having a thick piece of ginger held in the mouth.
- Moxibustion stick-on will support better sleep. Leave on the stick-on at KI-1 (yong-quan), insomnia point in foot reflexology and ST-36 (zu-san-li)
- Glucose and dark chocolate can provide immediate energy and some electrolyte balance when one suffers from diarrhea, tiredness and/or edema
Most people will find symptoms subside after a few days. You may find yourself free from most AMS symptoms with good preparation, meaning your body can swing into acclimatization smoothly. I took the preparation seriously every time, and it makes me more available to help with travel buddies when needed.
During the Return to Lowlands
Most people may ignore the de-acclimatization stage upon returning to the lowland. As the body has increased hemoglobin production to support increased oxygen-carrying demand during the acclimatization, it is equally important to support the ramp down without burdening of oxidation, mainly manifesting as tiredness. Following an antioxidant diet with aerobic exercise and antioxidant, adaptogenic herbs would be appropriate at this stage.
Types of Herbs
Multiple categories of herbs can support all three stages of traveling to high altitudes and they include:
- Adaptogens – Adaptogens increase the body’s resistance to physical, biological, emotional, and environmental stressors and provide a defense response to acute or chronic stress (D. Winston, 2019). Adaptogens work primarily via the Hypothalamic Pituitary Adrenal (HPA) axis, and are essential at all stages of trekking high altitudes.
- Qi Tonics – Qi is the life force in Traditional Chinese Medicine (TCM). Both lung and spleen qi are essential in modulating the ventilation and transportation of digested nutrients to where the body needs.
- Spleen tonics – Spleen tonics support efficient digestion so more energy can be preserved for other essential body functions when oxygen is depleted.
- Anti-hypoxic herbs – These enhance the energy metabolism of the body under hypoxia. It complements the adaptogens greatly.
- Circulatory herbs – These enhance blood circulation and the delivery of nutrients to the tissue and cells.
• American Ginseng – Nourishing, mildly stimulating adaptogen, mild nerve tonic, immune modulating, improve cerebral circulation, gentle stomachic
• Ashwagandha – Calming adaptogen, cerebral tonic, nervine (calming shen, insomnia), increases cardiorespiratory endurance, lowers cortisol (a stress hormone)
• Asia Ginseng – Ginseng Ginsenosides are neuroprotective under hypoxia, cardiotonic, nervine, and is a Kidney-lung yin tonic
• Astragalus – Replenishes vital energy, regulates water metabolism and reduces edema. It tonifies qi and blood and nourishes spleen qi
• Codonopsis – Qi tonic that helps with fatigue. It nourishes the lungs and generates fluids combating cold and dehydration at high altitudes
• Cordyceps – Nourishes lung, hypoxia tolerance, vasodilator, rejuvenating tonic for kidney
• Eleuthero – Tonifies qi, enhances physical capabilities and endurance, maximizes oxygen utilization, radio-protective, lowers blood viscosity and platelet agglomeration
• Ginkgo – Enhances cerebral circulation, vasodilation effect, helpful in cerebral edema at high altitudes, inhibits the production of free radicals under hypoxia, improves microcirculation and increases energy metabolism
• Red Sage / Dan Shen – Increases circulation, dispels blood stasis, reduces blood pressure, enhances cardiac function, and improves blood oxygen-carrying capacity under hypoxia. Dihydrotanshinone inhibits hypoxic pulmonary artery contraction;
• Reishi Mushroom – Calming adaptogen, nervine, improves sleep, oxygenates the blood
• Rhodiola – Warming dispersing adaptogen, invigorates blood, soothes qi, nourishes lung
• Schisandra berry – Calming, improves sleep, nourishes lung and kidney qi, hepatoprotective
• Triphala – an Ayurvedic classic formula comprised of Amalaki, Bibhitaki and Haritaki; Triphala is a superb bowel tonic, and it can tonify the gastrointestinal function. In addition, it has antioxidant, anti-inflammatory, hepatoprotective, and venoprotective properties.
Other herbs include Coca leaves, Dang Gui, Jiaogulan, Maca, Panax Notoginseng/Tienqi, Poria, Shilajit, Saffron, Seabuckthorn, Tibetan Green Orchid/Yi Ye Qing Lan.
All herbs have many properties that support the preparation, acclimatization or de-Acclimatization. Here is a simplified version of my take on some of these herbs:
A Holistic View
In addition to the herbal protocol, other aspects of life also come into all three stages including diet, exercise, and rest.
Natural protocols are great ways to help your body to prepare and experience the high-altitude journey. If you have a pre-existing medical condition, It is also important to seek medical advice before your travel to prepare for unforeseen circumstances.