Preparing for a Weekend at Altitude in Leadville
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A backcountry excursion in the Colorado Rockies is a bucket-list trip for many adventure seekers. The allure of a weekend exploring big mountains, finding solace in remote wilderness, and the prospect of bagging a fourteener has led many folks to make pilgrimage to Colorado’s peaks. For me, the draw was so strong that I eventually made Colorado my home. And I haven’t looked back.
Top Out Adventures’ 2021 Colorado season was a resounding success. Dave's ability to curate a diverse group of soon-to-be-adventure-besties is uncanny. Last year the weather was phenomenal, the food was exceptional, and the company kindred. Even better, everyone made it home healthy, happy, and unscathed–save for a few sore legs.
The one consistent complaint? Our good ol’ friend, altitude.
The Journey to Leadville
Nestled amongst the Sawatch range of the Colorado Rockies at 10,152’, Leadville holds the honorable distinction of being the highest incorporated city in the United States. Just one hundred miles from Colorado’s sprawling capital, Leadville is an outdoor paradise surrounded by several 14,000’ and 13,000’ peaks, punctuated by the understated, gritty local culture.
From a practical standpoint, this means there’s a good chance you’ll be making a significant change in altitude getting there. Those of you coming from sea level will be ascending more than 10,000’ in a single day, not an insignificant transition. And because how quickly you go up is a well known risk factor for developing an altitude-related illness, it’s likely that you’ll feel some effects shortly after you arrive.
How Altitude Affects the Body
High-altitude is generally considered to be anything above 8,000’. Most people tolerate an ascent to this point with little ill effect, though experiencing an altitude-related illness below this is possible and it does happen. Above that, the probability of adverse effects and their severity increase dramatically the higher you go. In one 1993 study of tourists at Colorado ski resorts, researchers found that nearly half of travelers surveyed at 10,000’ reported marked symptoms related to their altitude exposure.
Earth’s atmosphere is made up of 21% oxygen, 78% nitrogen, and 1% other gasses. This composition doesn’t change as we ascend–there’s not really “less oxygen” up there–but as the atmospheric pressure drops the density of the air also decreases. In turn, the amount of oxygen taken in each breath, something known as the fraction of inspired oxygen or FIO2, also goes down. At sea level, FIO2 will generally equal that of the atmosphere, about 21%. At 10,000’ feet this drops to approximately 14%. On the summit of Mt. Elbert–the highest point in Colorado–FIO2 falls to roughly 12%. That’s little more than half the oxygen you’ll get in each breath than at sea level.
The body immediately responds to this decrease through a cascade of physiologic events. In an attempt to deliver more oxygen to depleted tissues, respiratory rate increases along with a rise in both blood pressure and heart rate. Elevated respiratory rates lower the acidity of the blood, and your body must further compensate for this imbalance by excreting something called bicarbonate through the urine. This, in turn, leads to more frequent potty breaks.
In most cases, the body will adapt to its new environment–a process known as acclimatization–and symptoms will eventually subside. This process can take weeks or even months, however. Opinions vary widely, but some experts even suggest that fully adjusting to a significant change in altitude can take a year or more.
It’s also worth noting that, while the underlying physiology and risk-factors of altitude exposure are well understood and fairly consistent, an individual’s response across multiple exposures isn’t. Don’t make the mistake of assuming that because you had no issues in the past that your next trip will be problem free. Expect the best, prepare for the worst.
What is Altitude Illness?
Altitude illness normally occurs after a rapid ascent to altitude without adequate time to acclimate. Early effects of altitude illness are usually benign, but can quickly progress into a life-threatening condition if care is not taken. The larger and faster the ascent, the greater the risk.
Acute Mountain Sickness (AMS)
Mild to moderate altitude illness is referred to as acute mountain sickness, or AMS. It’s probable that you’ll experience at least a few of these symptoms to some degree after arriving in Leadville:
Increased respiratory rate, blood pressure, and heart rate.
More frequent urination.
Headache.
Shortness of breath with exertion–climbing a flight of stairs, for example.
Fatigue.
Nausea, possibly vomiting (Dave’s cooking notwithstanding).
Loss of appetite.
Decreased capacity for intense exercise–a slower pace, for example.
Insomnia.
Vivid, waking dreams.
These symptoms normally subside the longer you are at altitude, but keep in mind that this can take time. Don’t expect them to completely disappear in a day or two.
Severe Altitude Illness
As AMS progresses, two life-threatening conditions can develop: high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE).
Edema is a ten-dollar medical word that means “swelling”. Edema occurs when fluid becomes trapped within the body’s tissues–aka fluid retention–and can have a number of causes. If you’ve ever rolled an ankle, been pregnant, flown non-stop to the other side of the planet, or had a puffy face the morning after binging on pizza and Netflix, you’ve experienced edema.
Edema can also be caused by your body’s physiological response to altitude.
High-Altitude Pulmonary Edema (HAPE)
Pulmonary edema is fluid retention in the lungs. The increase in blood pressure that is commonly seen when traveling to high-altitude is caused by a narrowing of the blood vessels, a process called vasoconstriction. It’s hypothesized that this increased pressure in the lungs causes fluid to leak from the blood vessels into the lung tissue. Over time, this fluid will fill the lung’s air sacs, which can be fatal.
Signs and symptoms of HAPE include:
Many of the symptoms of AMS will still be present, potentially with greater severity.
Difficulty breathing or extreme shortness of breath at rest.
Cold, clammy skin.
Blue-tinged skin, lips, or nail beds.
A persistent, dry cough.
As the condition progresses, a wet, productive cough may develop.
According to the National Outdoor Leadership School’s (NOLS) Wilderness Medicine Institute, HAPE causes the largest number of deaths of all altitude-related illnesses. This could be because HAPE is more common and its symptoms are usually less alarming than its more serious cousin HACE, leading people to underestimate its danger and wait too long to act. The exact reasons aren’t completely clear.
High-Altitude Cerebral Edema (HACE)
Cerebral edema is fluid retention in the brain. Similar to HAPE, it is believed that HACE is caused by fluid leaking from blood vessels into the brain. This increases the pressure inside the skull, which can have devastating effects.
Signs and symptoms of HACE include:
Many of the symptoms of AMS will still be present, potentially with greater severity.
Difficulty controlling bodily movement, like walking straight. This is the best sign that HACE is serious.
An altered mental status. That is, someone who doesn’t know where they are, who they are, what time of day it is, and so on.
Loss of consciousness.
A headache may or may not be present, but if so, it’s usually severe.
Blurred vision, hallucinations, or seizures may occur in some individuals.
If you or someone with you has any of these symptoms, it is imperative that you descend rapidly and seek professional medical attention immediately. If you’re unable to get down, it’s time to call for help.
Treating Altitude Illness
The single most effective way to treat altitude illness is to descend, and mild to moderate symptoms usually disappear once you’ve reached a lower altitude. More severe conditions like HAPE or HACE will require professional care. You should be headed to the emergency room, not the spa at the Denver Airport Marriott.
Aside from cutting your trip short and heading home, treatment of mild AMS is mostly about addressing the symptoms.
Medication
Important: Always consult a qualified medical professional before making any changes to your medications, prescription or otherwise. Be sure that your provider is aware of any new medications you’re planning to take to ensure that there are no potentially dangerous interactions, and never stop taking any prescription medication without your provider’s approval.
Headache
Headaches associated with altitude can safely be treated using over-the-counter analgesics like ibuprofen or acetaminophen. In fact, when properly combined, acetaminophen and ibuprofen can be more effective at treating pain than many powerful narcotics. Unless you’re already taking it for an existing medical condition, leave the Aspirin at home. It’s a potent blood thinner that’ll make it more difficult to control bleeding if you take a nasty spill and it may interact with other medications used to treat AMS.
Always stick to the standard dosage on the labels. Large amounts of both ibuprofen and acetaminophen can cause potentially life-threatening complications. More is not always better.
Sleep
If you find yourself struggling to catch some Z’s, you may be tempted to take something to knock you out. Steer clear of sedatives like sleeping pills, narcotics, or benzodiazepines like Valium or Xanax (but never stop taking benzodiazepines without talking to your doctor first) for sleep, as they’ll leave you feeling groggy and wanting for more rest the next day.
Likewise for psychoactive sleep aids like Ambien. If you have experience with and well tolerate these then stick to your plan. But if it’s your first rodeo, Leadville ain’t the place, cowpoke. These types of medications can have wild, unpredictable side-effects like sleep walking. And no one wants to watch you fall down the stairs or see you half naked at the open fridge sleep-eating in the middle of the night.
Alcohol–also a depressant–is well known for its ability to wreak havoc on sleep quality. Sure, it’ll put you down for the count, but you risk an early morning knock at the door from a visitor called glutamate. Glutamate is an excitatory compound, and it’s why you sometimes wake up in the wee hours after a big night out. Your body attempts to rebalance the chemicals disrupted by the alcohol by releasing glutamate, which in turn wakes you up, only worsening the situation. Not to mention you’ll also be nursing a hangover the next morning.
Finally, experienced weed connoisseurs: do your thing, just please not in the house. Noobs: in case you haven’t heard, the recreational use of marijuana is legal in Colorado, and there are some well-respected dispensaries in Leadville. But think twice before chowing down on that bedtime chocolate bar, lest you find yourself tossing all night in a panic-attack-induced swamp of sweaty sheets or, even worse, hanging out with Naked Ambien Lady at the fridge stuffing your face with leftover pie. Yes, there will be pie.
So what to do? Your best bet is to optimize your overall sleep hygiene. Here are a few tips that should help you get to sleep faster, stay asleep longer, and get more deep sleep–exactly what’s needed to recover from a hard day in the mountains:
Give yourself some time to wind down. Exposure to the blue light and stimulus emitted by your phone will make it take longer for you to fall asleep. Shutting things down an hour or two before you hit the sack is a good rule of thumb.
Take a warm shower, meditate, pray, stretch–do whatever helps you to relax just before you turn in.
Part of why you’re in Leadville is to disconnect from the stresses of life back home. To that end, strive to limit your consumption of news, market reports, those never ending “emergency” work emails, Slack notifications, and the like as much as you reasonably can.
Be cool. Most humans sleep optimally at a temperature of about 68°F. Open a window, crack your door, and lose the extra blanket to keep from overheating.
Stay in the dark. Bring a sleep mask to block ambient light from street lamps, alarm clocks, smoke detectors, and other electronics. There are several good, relatively inexpensive options out there, just be sure to get a true “blackout” mask.
Put your phone into sleep mode to silence all of the social media notifications you’ll be getting throughout the weekend from your super jelly friends and family back home.
Prophylaxis
Another ten-dollar medical word, prophylaxis simply means “prevention”. So, let’s go ahead address the thousand-pound marmot in the room: Are there medications you can take to prevent altitude sickness?
The short answer is yes, with a few caveats.
Acetazolamide
If you’ve been digging around the Internet reading about high-altitude–or have already been there–chances are you’ve probably run across a medication called acetazolamide. Acetazolamide–more commonly known by its brand name, Diamox–is a drug that was originally developed for glaucoma patients, but that was eventually found to have benefits for treating altitude-related illness.
Acetazolamide works by reducing the respiratory alkalosis caused by your increased breathing rate. The pharmacology gets pretty complex, but in its simplest terms, acetazolamide causes you to excrete more of that pesky bicarbonate stuff we discussed earlier. This has the effect of substantially reducing or–if you’re really, really lucky–eliminating the symptoms of AMS and helping you acclimate faster.
So what’s the catch? There are a few:
Acetazolamide simply might not work for you and you may still experience some degree of AMS symptoms. No harm, no foul–but now you’re out twenty bucks, still feel like dirt, and may also be dealing with the side-effects of the medication itself.
Taking acetazolamide is not without risk. Like any pharmaceutical, it’s possible to experience a undesirable and potentially severe reactions. There are also possible interactions with other common medications–Aspirin, albuterol, and metformin, to name a few. This is why it’s so critically important to discuss any new medication with your primary care provider before you start taking it.
There are also potential side-effects. Dizziness, lightheadedness, fatigue, dry mouth, tingling fingers and toes, changes in menstruation, and numbness around the mouth are common. Acetazolamide is also a mild diuretic that will magnify the already increased urinary output you’ll be experiencing, furthering the importance of vigilant hydration.
There are a few different protocols for taking acetazolamide, most involving a pre-loading period. Missing this window could mean that the medication starts working about the time you’re headed home, so be sure to carefully read and follow the prescription.
Vasodilators
Vasodilation medications, also known as ED medications (yes, those) have also shown some promise in helping to treat symptoms of AMS and improving high-altitude performance. Vasodilation drugs work by increasing the production of a chemical in your body called nitric oxide, or NO. Nitric oxide has the opposite effect on your circulatory system as does altitude. Instead of causing the blood vessels to contract, it causes them to expand.
This vasodilation can help to alleviate some symptoms of AMS and may increase athletic performance. Competitive athletes beware: taking these banned substances while participating in WADA-sanctioned events can land you in some serious hot water. But don’t fret. There are some effective, competition-legal dietary alternatives for increasing NO production that we’ll cover shortly.
Preparing for Altitude
While there are no guarantees that altitude illness can be prevented, there are several things you can do to stack the deck in your favor. With the possible exception of an extended acclimatization period, no single option outlined here stands above the rest. A comprehensive plan that includes a combination of all of these offers the best chance of mitigating the severity of the symptoms you’ll experience.
Acclimate
Again, your single best option to prepare for high-altitude is to acclimate, by simply slowing your rate of ascent. Spending a couple weeks enroute to Leadville obviously won’t be practical for most people, but even a day or two at an intermediate altitude–say, Denver–will likely yield some benefit.
Beyond that, there are a few other things you can do once you arrive in Leadville to help ease the acclimatization process.
Stay hydrated. Avoid sugary beverages like sports drinks and sodas.
Teetotal. Alcohol is a diuretic that can magnify the effects of dehydration.
Be mindful of your nutrition, particularly since your appetite may be reduced.
Sun’s out, guns out! Exposure to natural sunlight will help to reset your circadian clock, which will reduce the effects of jetlag and help improve sleep.
Prioritize rest, but don’t use this as an excuse to nap all day. Think active recovery–a brisk walk around town, a short hike, or a yoga class are all good options.
Another common recommendation is to avoid caffeine, the idea being that it also contributes to dehydration. There’s little compelling research to back this statement up, and there’s actually evidence suggesting that–particularly for regular caffeine users–there’s little diuretic effect at all. That said, caffeine does cause a temporary rise in blood pressure and it isn’t going to help you sleep. Go ahead and enjoy that morning cup of joe, just don’t pound the whole pot.
Hydration
Hydration per-se won’t do much to improve your AMS symptoms. However, the additional fluid and electrolytes you’ll lose from more frequent urination and the dry Rocky Mountain air put you at greater risk for dehydration. Dehydration can further contribute to headaches, fatigue, and diminished athletic performance, robbing you of your ability to push hard on the trail in the days ahead.
It’s also crucial to show up hydrated. In the days leading up to your arrival, make it a point to drink an adequate amount of water, and maybe take a hard pass on that pub crawl the night before you leave. This doesn't mean that you should try to pre-hydrate, however. While rare, overhydration can result in a potentially life-threatening electrolyte imbalance called hyponatremia (literally, “low blood salt”), which can be far more dangerous than dehydration.
You might also consider adding a low- or no-sugar electrolyte supplement to your water. Several excellent pre-packaged options are available–visit your local running store or outfitter–or you can make your own. A teaspoon of fresh squeezed lemon juice and a pinch each of Celtic and Himalayan sea salt added to a liter of water will cover your electrolyte needs, tastes good, and is super inexpensive.
Note that most off-the-shelf, sweetened sports drinks and sodas usually contain high levels of high-fructose corn syrup (HFCS). Highly refined sugars like HFCS contribute to chronic inflammation in your body and spike your blood glucose levels. This further impedes your ability to recover from exercise and begs for the dreaded afternoon sugar crash. Leave these at home where they belong–in the garbage can.
Nutrition
What you eat can also play a role in adjusting to and performing well at altitude. There’s no silver bullet, but it doesn’t matter how you eat–carnivore, Paleo, keto, pescetarian, vegan, vegetarian, the taco diet, or something else. Eating clean is what counts. Yes, the taco diet is a real thing, sort of. Yes, there will be tacos.
I was originally going to start with a list of what not to eat. But you’re all adults. You already know what’s not good for you and I’m certainly not here to shame anyone for their dietary choices. So I’ll just say this: if you know it’s bad for you at home, know that it’s probably worse for you at altitude. Consider cutting those things out of your diet–I’m, ahem, looking at you fast food and refined sugar–before and for the duration of the trip.
Let’s instead focus on some things you should eat. Many foods are natural, potent vasodilators. Similar to vasodilation medications, these also increase nitric oxide levels in your body, causing your blood vessels to relax and blood flow to increase. Gents, pay close attention here–this is also an important life-hack that has firm benefits.
Consider making some or all of these nitrate-rich options a regular part of your culinary repertoire a few weeks before you depart:
Cayenne and ceylon cinnamon, both clinically proven to lower blood pressure.
Garlic and onions. These also contain high levels of an important precursor to your body’s master antioxidant, glutathione, instrumental in recovery and healing processes.
Dark leafy greens like spinach and collard or mustard greens.
Fatty fish like salmon. Opt for wild caught, sustainable options if possible.
Watermelon. Pro-tip: get down Dirty-South-style and dip it in a high-quality sea salt.
Dark chocolate. Choose a fair-trade offering that’s at least 80% cacao.
Pepitas, aka roasted pumpkin seeds. These also make an excellent trail snack.
And perhaps the most popular amongst endurance athletes: beets. There are several beet root powder supplements available if you’d prefer not to remove stains from your fingers, kitchen counters, walls, floors, dish towels, pets, and children.
A Final Word on Fitness
I have a bit of disappointing news: a high level of physical fitness does not necessarily correlate with an improved tolerance for altitude. Countless elite-level athletes have suffered when competing without sufficient acclimatization. The 1968 Olympic Games are a perfect example. Held at 7,349’ in Mexico City, there was an unusually high number of lackluster performances in endurance events, a phenomenon that was eventually attributed to the altitude. That year’s Games sparked considerable new research interest into high-altitude athletic performance, and is partly why so many professional athletes now live and train around cities like Colorado Springs, Flagstaff, and Tahoe.
But before you run your training plan through the shredder, understand that a low level of fitness will definitely make your time in Leadville less enjoyable. You’ll be spending three long, leg-torching days climbing steep ascents and navigating technical downhills. Trails in the Colorado Rockies are hard packed and rocky, meaning more impact on your feet and joints. And while the pace is typically relaxed–we want you to spend as much time as possible taking in all the outdoor beauty that Colorado has to offer, after all–unpredictable mountain weather or an emergency could mean that we have to hustle to stay safe.
So while being fit might not help with altitude directly, being prepared for the strenuous conditions will make you less aware of it. And you’ll have more fun as a result.
You should always consult a competent healthcare provider or coach before making any major changes to your exercise routine, but here are a few things to consider when preparing for your trip to Leadville:
Spend ample time-on-feet. Expect to spend upwards of six to eight hours each day on the trail. Simulate these conditions as best you can–by spending long, consecutive days carrying your full pack, for example.
Build a solid aerobic base. Focusing on longer, lower heart rate workouts will help you develop the endurance you’ll need for longer efforts with the added benefit of delivering that much needed time on the paws.
Pick up heavy stuff, then put it down. Strength training helps prevent injury by building durability and conditioning muscles–your core, for example–that fatigue during long days of climbing and descending. Exercises like kettlebell swings, squats, and deadlifts offer some of the biggest bang for your buck.
Prioritize mobility and recovery. Taking care of sore muscles and getting adequate, quality, sleep are two of the best ways to help ensure that you show up healthy. Massage, foam-rolling, yoga, sauna, and even meditation all will have a significant impact on your recovery and your ability to push hard for multiple days on tired legs.
We hope these tips prove helpful in preparing for your trip to Leadville. Any questions, comments, or feedback, reach out to us at topoutadventures.com.
Can’t wait to see y’all in Pb!
Be well.
-k
References:
Acute Mountain Sickness in a General Tourist Population at Moderate Altitudes. PubMed.org. Accessed July 22, 2022.
High-Altitude Physiology. Auerbach's Wilderness Medicine, 7th ed. Elsevier, November 2, 2016.
Tod Schimelpfenig. Case Study: Finding A Sick Person High In The Mountains. NOLS. Accessed July 22, 2022.
Acetazolamide. Prescriber’s Digital Reference. Accessed July 22, 2002.
Sildenafil Inhibits Altitude-Induced Hypoxemia and Pulmonary Hypertension. PubMed.org. Accessed July 22, 2022.
Caffeine at High-Altitude: Java at Base Camp. Peter H. Hackett, High Altitude Medicine & Biology, Volume 11, Number 1. Mary Ann Liebert, Inc. 2010. pp 13-16.
Altitude Training. Wikipedia. Accessed June 22, 2022.
About the Author
Kristopher Cargile is a Lead Guide and Trip Host at Top Out Adventures. He’s a nationally and Colorado-certified Wilderness EMT, an avid student of fitness and performance nutrition, and an experienced long-distance runner. Connect with him at https://kristopherleecargile.com or on Instagram at @kristopherleecargile.
