Getting High in Colorado
From Jacob Schor, ND, FABNO, 2013 Speaker Selection Committee Chair
There is a medical condition called “Altitude Sickness” and for those of you unfamiliar with it, this letter is going to give you a bit of advice on how to avoid it and how to treat it. Below I'll paste the text of a handout that Kim Nearpass and Justin Pollack wrote and use at their clinic in Frisco, (elevation 9,075 feet), just down the road from where we will hold the conference. The two of them are huge fans of Acli-Mate, a powdered drink mixture manufactured and sold by another colleague, Roanne Rouse-Houck who practices in Gunnison (elevation 7,703 feet). Roanne tells me that her magic powder works best if you start drinking it a few days prior to when you need it. Thus you might want to contact her ahead of time.
There are a few other tricks to dealing with altitude sickness that are worth mention.
Our beloved Jody Shevins who has practiced in Boulder for something like 30 years recently shared this advice on treating and preventing altitude sickness:
“….Skating along a creek swollen with spring snowmelt from the high peaks that I see in the distance, the pelicans and cormorants, ospreys and herons are flying about. I notice that I have a ridiculous grin on my face from the blissed out state I am in. It is so fantastically beautiful here and even more so in the rarified air of the high peaks, not to mention all of our high spirits from the success of our bill. I got to thinking about how many of you are coming to Colorado to learn and celebrate and share the magnificence of our state. If you are on the fence about coming to the AANP Convention, hop on off and please come!!!
To have the best time possible while you are here, I would like to share my favorite altitude assists. Especially for those of you coming from sea level, the gain in altitude is significant. There really is less oxygen, and it is not only high but quite dry. From the moment you get off the plane, start drinking a lot more liquid than you usually do. Water, water and more water (and electrolytes). Eat regularly and maintain your blood sugar. Also, be careful, alcohol has a bigger effect here than at sea level.
When I treat people visiting from sea level who struggle with the altitude, my best results come with homeopathic Coca in a 6 or 30C potency. I suggest taking it every few hours and/or in a water bottle spiked with the remedy. My Tibetan trekkers also love it. Some people swear by gingko, CoQ10, dimethylglycine and an assortment of adaptogenic mushrooms like Cordyceps and Reishi. Start soon with your favorite oxygen enhancing formulas. If you are the least bit anemic, you have time to correct that before you get here next month. Some people are prone to swell a bit with the altitude. For them I have found a combination of Apis 30C and electrolyte replacement does the trick. If you prepare and take care while you are here, you will feel well and have a fantastic time.
The Coca seems the best go-to remedy in my experience, although remedies like Carbo Veg and Glonoine can help if that fits your pattern….”
My personal favorite has long been the Cataplex E2 tablets sold by Standard Process. My impression though is that rather than a treatment for altitude sickness they work best when simply used to increase ability to exert at high altitude, kind of increasing the amount of oxygen that reaches your muscles.
I also am a big fan of the little orange flavored fizzy drink powders that Jim Massey's company Mountain Peak Nutritionals has sold for years. This is more of an electrolyte replacement drink than a cure for mountain sickness that Jim developed for mountain bike racers while living in Durango, Colorado (elevation 6,512 feet) a number of years ago.
There is a relatively new development in treating altitude sickness that we might consider. It seems that increasing nitric oxide production may reduce symptoms of altitude sickness.i The research on this idea though has not been conclusive, for example a 2011 RCT using Viagra found no benefit nor did a RCT supplementing with l-arginineii, though a 2001 trial did report some improvement in symptoms.iii Coming to Keystone will give you the opportunity to do some in-office research where n= you.
Probably the biggest help for lowlanders will be to focus on staying fully hydrated. At the lower barometric pressures, water evaporates far more quickly than at sea level. Add the bright sun and the low relative humidity, we lose far more water to perspiration and respiration than at sea level. One needs to drink far more fluid. Justin and Kim suggest two liters a day. Even on cold ski days, I think I consume a gallon of water a day. Basically if you are using the restrooms between lectures you aren't drinking enough. (Speaking of drinking, alcohol is a different story at high altitude. Alcohol's effects increase with altitude so don't be surprised if you suddenly discover that you are a cheap drunk.)
Below is Kim and Justin's handout (you can click here to download it):
Welcome to the high country! You came here to enjoy yourself, relax and get away, not contend with a pounding headache, shortness of breath, restless nights, or nausea. High altitude is defined as altitude over 5,000 ft, and most of the mountain towns in Summit County range from 8,000 to 10,000 ft. Most people are affected at elevations greater than 8,000 ft., with nearly 100% feeling some shortness of breath, and decrease in exercise tolerance. The oxygen at this elevation is 40% less dense than at sea level, and has 50-80% less humidity.
Acute mountain sickness (AMS) is the most common form of altitude sickness, and will affect 20-30% of visitors from low elevations. Symptoms of AMS include headache, along with one or more of the following: loss of appetite, nausea or vomiting; fatigue or weakness; dizziness or light-headedness; difficulty sleeping; confusion; staggering gait. Most people will have their symptoms clear spontaneously within 2-3 days, but before that much of a mountain vacation is wasted feeling miserable, they should know that we have effective, natural remedies available at the Mountain-River Naturopathic Clinic.
If the symptoms of acute mountain sickness persist for more than 2-3 days, the person may need to return to lower elevations. Life-threatening forms of high elevation related illness are less common, but include H.A.C.E. (High Altitude Cerebral Edema) and H.A.P.E. (High Altitude Pulmonary Edema). HACE occurs when the brain swells and stops functioning properly. Symptoms include loss of coordination and severe confusion, and it can be fatal within hours. HAPE occurs when fluid builds in the lungs, with symptoms leading up to it being extreme fatigue, and other respiratory symptoms such as a dry, incessant cough and chest tightness. A much less serious complication of altitude is H.A.F.E. (High Altitude Flatulence Expulsion), which is due to expansion of air that is trapped in the digestive tract.
NATURAL REMEDIES FOR AMS
For treating the symptoms of acute mountain sickness, the Mountain-River Naturopathic Clinic carries a special formulation of herbs and nutrients from an ND from the Gunnison area. It comes as a sweet lemon/lime powder that is mixed into filtered water called “Acli-Mate”, and we have found it to be highly effective at helping people who are suffering from AMS to get better quickly. The blend includes herbs Ginkgo biloba and Rhodiola, both of which have proven effective in preventing and treating altitude related sickness in small independent studies (1,2,3), and in hundreds of years of use. Both herbs seem to improve circulation, especially through cerebral vessels, and cellular energy function through improved uptake and utilization of oxygen (especially in the brain and nervous system), reducing toxic brain edema (4, 5). Ginkgo has also been shown to inhibit platelet clumping and stickiness, keeping red blood cells evenly dispersed, which improves delivery of oxygen to tissues (6), while rhodiola appears to help the body deal with stress.
Nutrients in “Acli-Mate” include vitamin C, and many of the B-vitamins: thiamin (B-1), riboflavin (B-2), niacin (B-3), pantothene (B-5) and cobolamin (B-12). The B-vitamins are usually found in combination in foods, and have similar coenzyme functions: working as catalysts for many biochemical reactions, including the utilization of oxygen and carbohydrate for energy production by the mitochondria of the cells, and the normal functioning of the nervous system. Vitamin C acts as a major antioxidant, protecting nutrients like the B-vitamins, and helping the body deal with stress.
Prescription Alternatives, Summit County's compounding and natural pharmacy, carries DMG (dimethylglycine), a supplement that improves oxygen utilization and cellular respiration, decreases lactic acid buildup, and enhances carbohydrate and lipid metabolism. Many visitors have found DMG to be helpful in alleviating headaches and other symptoms of AMS, and several decades of use by doctors and clinicians without adverse or negative side effects, have shown it to be a safe supplement.
For nausea and vomiting, ginger root has been used traditionally and clinically for centuries, with great effectiveness. Natural markets in summit country (Natural Grocers/Vitamin Cottage – Dillon; Alpine Market – Frisco; Amazing Grace – Breckenridge) carry candied and dried ginger that can be eaten as snacks, as well as ginger tea, which can have the added effects of warming the body and improving circulation while hydrating the system. The Mountain-River Naturopathic Clinic also carries several herbal combinations for sleeplessness, which don't have the side effects of most pharmaceutical sleep aids.
DRYNESS: CHAPPED LIPS AND NOSEBLEEDS
There is 50-80% less humidity in the air here (over 8,000ft) than at sea level. Moisturize your lips (and smear some in your nostrils) with lip balms or salves that contain vitamin E, sunscreen, and the herb calendula.
Even when it is cloudy, the risk of sunburn is extreme at this elevation. Avoid sunburn and injury to your eyes by wearing applying sunscreen, SPF 15-30, before going outdoors, and every 2 hours during activity out there.
Don't C.R.A.S.H., by making sure you do the following:
• Carbohydrate consumption increased.
• Reduce alcohol and caffeine.
• Activity in moderation.
• Salt intake decreased.
• Have more WATER (2 liters each day. Add another glass for every drink with caffeine or alcohol).
1. Maakestad K, Leadbetter G, Olson S, Hackett P. Ginko biloba reduces incidence and severity of acute mountain sickness.(Abstract) Proceedings Wilderness Medical Society Summer Conference, Park City, Utah. August 9-12, 2000.
2. Roncin J, Schwartz F, D'Arbigny P: Acute Mountain Sickness (AMS)/Vascular Reactivity to Cold. Aviation, Space, and Environmental Medicine 67, 445-452, 1996.
3. Zhang ZH, Feng SH, Hu GD, Cao ZK, Wang LY. “Effect of Rhodiola kirilowii (Regel.) Maxim on preventing high altitude reactions. A comparison of cardiopulmonary function in villagers at various altitudes” [Article in Chinese] Zhongguo Zhong Yao Za Zhi. 1989 Nov;14(11):687-90, 704.
4. Clostre, Neurologic Psychiatrie, special issue1, 33-41: 1989.
5. Spinnewyn, et al. Recent Results in Pharmacology and Clinic. Springer-Verlag Berlin, 143-52: 1988.
6. Artmann, et al. Hemorheology. 9:44, 1989.
ii. Mansoor JK, Morrissey BM, Walby WF, Yoneda KY, Juarez M, Kajekar R, Severinghaus JW, Eldridge MW, Schelegle ES. L-arginine supplementation enhances exhaled NO, breath condensate VEGF, and headache at 4,342 m. High Alt Med Biol. 2005 Winter;6(4):289-300.
iii. Schneider JC, Blazy I, Déchaux M, Rabier D, Mason NP, Richalet JP. Response of nitric oxide pathway to L-arginine infusion at the altitude of 4,350 m. Eur Respir J. 2001 Aug;18(2):286-92.