The Tricky Business of Treating Altitude Sickness


From the New York Times (December 8, 2015)

When the pop band Panic! at the Disco played in Colorado at the Red Rocks amphitheater more than a mile above sea level, the frontman, Brendon Urie, joked that his “drug of choice” was oxygen. Mr. Urie tripled his elevation to 6,400 feet when he traveled from a gig in Las Vegas to the stage outside Denver in October, so he kept an oxygen tank nearby for quick hits when he felt what he called “lightheaded” during the performance.

“It acted as a kind of security blanket,” he said in an email.

And there are a lot of security blankets being sold to Rocky Mountain visitors: oxygen therapies, oils, pills and wristbands, to name a few. They come with claims of preventing or reducing altitude sickness, promises that in most cases aren’t backed by research.

Still, many skiers are willing to spend freely on these treatments, and perhaps it’s not surprising. People can be desperate to salvage their vacations when the thin air causes headaches, nausea, fatigue, dizziness and worse. But acute mountain sickness (AMS) can be a serious condition, so it behooves travelers to understand that it can often be prevented, and that if it strikes, not all remedies are equal.

Over the last two decades, 32 people have died in Colorado from the effects of high altitude, according to data provided by Mark Salley, spokesman for the Colorado Department of Public Health and Environment. In addition, there were 1,350 trips to the state’s emergency rooms for altitude sickness last year, with 85 percent of those patients coming from out of state, he said.

Not everyone is affected by altitude, but among visitors to Colorado’s Summit County — location of the ski resorts Breckenridge, Copper Mountain, Arapahoe Basin, Loveland and Keystone — 22 percent of those staying at 7,000 to 9,000 feet experienced AMS, while at 10,000 feet, it rose to 42 percent, according to medical studies cited in an article by Dr. Peter Hackett and Robert Roach published in The New England Journal of Medicine in July 2001.

It’s impossible to predict who will be affected, though research has found that those who are obese tend to be more susceptible. Meanwhile, those over age 60 have a slightly lower risk. But whether a person is a child or adult, male or female, fit or out of shape doesn’t seem to make a significant difference, said Mr. Roach, now director of the Altitude Research Center at the University of Colorado Anschutz Medical Campus in Aurora, Colo.

Acute mountain sickness is caused by the lack of oxygen in the lower air pressure that exists at higher altitudes. It usually doesn’t affect people below 8,000 feet, although it can, according to the National Institutes of Health.

“It’s horrible,” said Laura Lane, 32, who, despite living at 5,000 feet in Fort Collins, Colo., is one of those routinely affected by higher elevations. Early on, it makes her nauseated and gives her a “crushing” feeling, while simultaneously making her feel as if her head “is being split in two,” she said.

Once, after toughing it out on an overnight hiking trip to about 10,000 feet near Vail, Colo., she ended up so sick she needed help descending.

“It’s kind of like being drugged; you’re somewhat delirious,” she said. “It affects your ability to think and comprehend. You lose cognitive functions.”

For future trips, her doctor prescribed acetazolamide, sold as Diamox, one of the few proven AMS drugs. Acetazolamide is generally given in a dosage of 500 to 1,000 milligrams daily, beginning 24 to 48 hours before ascent. One problem with it, however, is that it can have unpleasant side effects.

In Ms. Lane’s case, she described feeling “quivery and shaky” on 500 milligrams a day. Her doctor then halved her dose, and that has helped, she said.

“Diamox makes you breathe more,” Mr. Roach said. “It speeds up the acclimatization. The faster you are acclimatized, the sooner you are resistant to mountain sickness.”

Acetazolamide, which requires a prescription, can also treat mild and moderate altitude sickness even after a person is experiencing symptoms, according to research cited in The New England Journal of Medicine article.

Studies involving other hopeful AMS treatments have yet to show solid evidence that they work. These include ibuprofen (a study published in the December 2012 issue of the journal Wilderness and Environmental Medicine), Ginkgo biloba (in that same journal in March 2009) and nitric oxide (the April 1, 2012, issue of Free Radical Biology & Medicine).

Nonetheless, products containing these and other ingredients are sold for altitude relief throughout ski towns and on the Internet. A spokeswoman for the Food and Drug Administration, Lauren E. Sucher, said the agency does not discuss specific products.

Many of these would-be solutions cost only a few dollars a day, but some are pricey. The Spa at the Madeline Hotel in Telluride, Colo., for instance, offers a 90-minute “Altitude Revival” massage ($210) that includes a glass of “oxygen-rich structured water” and puffs of “pure oxygen,” followed by a massage “specifically for altitude adjustment.”

It features the “High Altitude Body Oil” made by ISUN Alive & Ageless Skincare that claims it “supports adaptation to high altitudes.”

The ingredients in the $40-a-bottle oil are based on “botanical textbook information about the composition of herbs and oils,” said Bunnie Gulick, ISUN founder and chief executive.

“If you need hard-core, precise evidence about the product itself, or precise clinical studies … I cannot put my finger on them,” said Ms. Gulick, whose training is in nutrition.

Mr. Roach, a leading researcher in the human response to high altitude and a chairman of the International Hypoxia Symposium, said that as far as he knew, “there is nothing that when rubbed on the skin serves to prevent AMS.”

Additionally, there’s no evidence that “so-called oxygen-enriched water will have any impact on oxygen levels in the blood,” Mr. Roach said. The machine at the Madeline for “pure oxygen” actually uses 40 percent oxygen-enriched air, according to the spa director, Tricia Avery.

But oxygen is the focus of many “cures” marketed to visitors for high-altitude issues.

A ski-in, ski-out rental home in Telluride, Colo., offers four oxygen-infused bedrooms “that mimic being at a lower altitude” for $1,400 a night. The St. Regis in Aspen, Colo., has an “altitude concierge,” who recommends that guests feeling the 8,000-foot elevation start at the hotel’s oxygen bar, available with a $50 day pass to the spa.

“If they needed something a little bit more, then I would do an oxygen concentrator to sleep with,” said the concierge, Stephanie Madrid. They rent for $100 a night, or $300 a week.

Breathing at an oxygen bar might provide some temporary relief, but has no lasting effect, Mr. Roach said. As for supplemental oxygen at night, people will sleep better, but they won’t be acclimatizing during that time, he said.

The best way to avoid altitude sickness is to ascend gradually, and either stop at a lower altitude for a night or return to one to sleep. Visitors should avoid alcohol and plan their vacations so they don’t overexert themselves in the first 48 hours, according to the Centers for Disease Control and Prevention. If a gradual ascent isn’t possible, Diamox might be appropriate, the C.D.C. said.

It’s also important for visitors to know the signs of AMS, and, the C.D.C. cautions, “A person whose symptoms are getting worse while resting at the same altitude must descend or risk serious illness or death.”

To use the words of Lady Gaga, who posted a photo of herself in an oxygen mask on Instagram last year after being hospitalized in Denver: “Altitude sickness is no joke.”

A version of this article appears in print on December 13, 2015, on page TR2 of the New York edition with the headline: Little Evidence for Some ‘Cures’ for Altitude Illness.