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altitude acclimatization - IHE etc

Original Post
kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608

Looking for new approaches to acclimatization.

I live at sea-level but like to take week-long climbing + skiing trips to 10000-15000 feet. I don't acclimatize well: without special precautions, I tend to start feeling nauseous or lethargic climbing up when I get to like 7500ft (I guess these are symptoms of AMS). Then I wouldn't be comfortable at 10000ft until like my third day. Losing two or three days out of a one-week trip didn't seem worth it.

So for lots of years I've been taking acetazolamide a couple of days before I leave. That seems to work OK ... I still feel it some on my first day of climbing up, then by the second I'm pretty comfortable climbing up to 10000ft -- and I've gotten well-accustomed to handling the side-effects. But climbing up over 15000ft on Mont Blanc I still felt lethargic even several days after I arrived in France.

Decided to take another look at it, reading on the web about hypoxic exposure -- altitude tents or breathing masks. Here's what I'm finding:

  • Seems like the prices on the "molecular sieve" or membrane separators (to replace O2 with N2) have come down some (but still plenty expensive) - (see helpful summary comparison)
  • A process I hadn't seen before: Using re-breathed air to reduce the O2, then putting it thru a "silo" to soak up some of the excess CO2, seems less expensive.
  • Lots of studies showing that Intermittent Hypoxic Exposure (IHE) can increase red blood cell count and therefore improved utilization of O2 at higher altitude. Seems like this might be a useful "side effect" for me finding a new approach to acclimatization - (though perhaps with increased risk of embolisms?)

but ...
  • maybe IHE doesn't work for short-term acclimatization like I want. As in
this study
by the U.S. Dept of Defense.

Pre-Exposure during one week in advance, to reduced O2 pressure with total pressure normal sea-level, did not help with short-term acclimatization.
(That finding at first surprised me, but then made sense -- for the samed reason acetazolamide does help me acclimatize even though it has no effect on red blood cell count or oxygen utilization).

The summary of the DoD suggests that what really does work is pre-exposure to reduced Total pressure atmosphere - (but a simulated environment for that is very very expensive).

Or is there some other new trick?

Ken
Bapgar 1 · · Out of the Loop · Joined Oct 2007 · Points: 85
Buff Johnson wrote: Any chance you could take more time off?
Thinking about the total cost involved I was wondering this very thing. Take a few more days off and just hang out doing casual touristy stuff wherever you're planning on playing.
NickinCO · · colorado · Joined Sep 2010 · Points: 155

If you really wanted to do something like that, find a friend that is a technical diver or make friends with a local dive shop operator. A common fill of trimix is 18/45 or 18% oxygen, 45% helium. You could get the training in order to get the fill, get yourself a few tanks and a full face mask and a treadmill and go to town. Not sure if it'd be really worth it to you though. My trimix training and gear cost me nearly $5,000 and filling the tanks are about $130 a pop because of the cost of helium.

Mike Washburn · · Orem, Utah · Joined Sep 2009 · Points: 30

I haven't heard of this being done by mountaineers, but I know that athletes sometimes blood dope. They draw a unit or two of blood a couple of weeks prior, spin off the red blood cells, and reinject them prior to need to increase O2 transport capacity. Side effects could be increased risk of embolism and the other symptoms of polycythemia. Staying hydrated as well as possible would be important. Any thoughts on this?

Loren Trager · · Flagstaff, AZ · Joined Jun 2011 · Points: 165

I don't mean this to sound sarcastic, but move to a higher altitude and work out more. IHE sounds tempting, and probably does work for a number of people (long-distance bike racers), but regular endurance training is the way to go. Climb whenever you can.

Follow the usual advice when you're at altitude, like drinking plenty of water and eating lots of carbs. Check out something called a Gamow bag, and if you're not opposed to taking meds, dexamethazone will clear that altitude sickness right up. Or...you could also acclimate the natural way and just take it easy the first couple days.

Aerili · · Los Alamos, NM · Joined Mar 2007 · Points: 1,875
Mike Washburn wrote:I haven't heard of this being done by mountaineers, but I know that athletes sometimes blood dope. They draw a unit or two of blood a couple of weeks prior, spin off the red blood cells, and reinject them prior to need to increase O2 transport capacity. Side effects could be increased risk of embolism and the other symptoms of polycythemia. Staying hydrated as well as possible would be important. Any thoughts on this?
I think blood doping is just not worth it. Blood becomes much more viscous doing this and can be a risky and dangerous practice.
kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608
Nick Mardi wrote:find a friend that is a technical diver or make friends with a local dive shop operator. A common fill of trimix is 18/45 or 18% oxygen, 45% helium . . . My trimix training and gear cost me nearly $5,000
Thanks a lot for such a creative suggestion ... but for that money I could almost buy two "molecular sieve" / membrane separator machines. (I'll guessing that the need to handle helium for divers boosts the price. Non-divers are happy with extra nitrogen)

Ken
kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608
Mike Washburn wrote:I haven't heard of this being done by mountaineers, but I know that athletes sometimes blood dope. They draw a unit or two of blood a couple of weeks prior, spin off the red blood cells, and reinject them prior to need to increase O2 transport capacity. Side effects could be increased risk of embolism and the other symptoms of polycythemia. Staying hydrated as well as possible would be important. Any thoughts on this?
My unexpert thoughts about blood doping ...
This is a more direct form of what people are trying to achieve by using altitude tents or IHE with masks: increase red blood cell count. I think there's abundant evidence that it improves aerobic muscular performance at altitude (or at sea-level just as well).

Fundamental shortfall of all the different methods for increasing red blood cell count is that I don't see how that addresses my problem of AMS symptoms - (that's the point of that DoD study). My goal is not to go uphill 5% faster so I can place 6th instead of 19th in some alpine speed-climbing race. Rather I just want to avoid feeling nauseous and lethargic so I barely feel like climbing at all.

My theory (also in some books) is that the cause of some of the AMS symptoms is reduced partial pressure of carbon dioxide CO2 -- not an oxygen problem. Thus for example the drug acetazolamide addresses that by modifying the buffering of carbonic acid in my blood. Otherwise the concentration of carbonic acid drops thru exhange of CO2 with thinner air, and my blood pH rises. So the obvious theory is that many symptoms of AMS are a result of alkalosis.

Therefore, one idea is that I could try filtering sea-level-pressure normal (non-rebreathed) air thru one of those CO2-soaking "silos" (e.g. from AltoLab) into a breathing mask, and try intermittent sessions of exposure to reduced-CO2 air during the week or so before I go on my trip -- and see if that induced some early adaptation of my carbonic acid buffering - (instead of waiting for my body to make the same adaptation three days after I arrive).

But it's just a theory and I've never tried anything like that before and I don't know the risks (other than feeling nauseous and lethargic before I've even left home).

Ken
chris vultaggio · · The Gunks · Joined Dec 2008 · Points: 540

I'm preparing for a trip to thinner air in 4 months, and have been adding a few supplements to the mix in addition to training - chlorophyll drops (closest thing in nature to hemoglobin) and blood builder pills, totally food-based.

While both promote blood health and are said to increase RBC count and make delivery of hemoglobin more efficient, I am wary of too much - don't want to bring blood to too a viscous state.

Once at altitude the body compensates in many ways, including pulling plasma from blood to increase O2 efficiency which makes it thicker.

Hoping the supps will help, but really relying mainly on a long acclimation (almost a week) period before we start any serious climbing.

Also of the mindset that diamox etc should not be used prophylactically , but we'll have it on hand for any issues higher up.

kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608
chris_vultaggio wrote:... diamox etc should not be used prophylactically
Well you haven't said how high you're climbing or how high you're sleeping or what the group social dynamics are.

I've been taking acetazolamide / Diamox prophylactically for multiple trips per year for over 20 years -- gotten reliable results with no problems other than well-known side effects that I could easily manage. I believe it's been studied lots for prophylactic use since decades ago. My prescribing doctor is fully aware of me starting to take it two days before leaving on a trip -- indeed those were his instructions.

My context is that I never climb higher than 15000 ft and never sleep higher than 10000 ft. And I'm responsible for my own use only, not a whole group of climbers.
What I've heard is that normally the best treatment for unexpected serious altitude-related problems is retreat to lower altitude.

Well for me "retreat" is my normal climbing plan after I've reached the summit. I love hanging out down in the valley -- not much interested in sticking around in huts or tents that lack convenient Web access or boot dryers.

On the other hand, if I were leading a larger group, at higher altitudes, with high camps in possibly bad weather where retreat might be dangerous, perhaps I'd have a policy against prophylactic use.

Ken
chris vultaggio · · The Gunks · Joined Dec 2008 · Points: 540
kenr wrote: Well you haven't said how high you're climbing or how high you're sleeping or what the group social dynamics are. Ken
+6000m

Sounds like what you're doing is working for you - just go in healthy and give yourself plenty of time to adjust to the lower O2 pressure.
Marc Reich · · Boulder, CO · Joined Sep 2010 · Points: 20

Last year i was using ginko biloba before high altitude runs. 120mg 2x a day with food (that was just the size i got, they come in different doses, but ive read at lease 100mg 2x a day is whats required for the effects). Its also supposed to help focus and whatnot. I beleive it works by thinning the blood slightly. Start at least 5-7 days before altitude exposure. It also may have help me sleep better (not sure about confounding variables here).

I also considered iron supplements. Iron is important in red blood cell production and oxygen delivers. Didn;t try it yet but probably will try it as my mileage increases (also heard its good to help muscle recovery for these reasons-dont quote me on this tho). Be careful tho, as you can have too much iron.

If you're taking another drug for altitude, i wouldn't take either of the above without research or talking to a doctor. Your results probably won't be as dramatic as a Rx drug, but it should help a bit. Of course, staying hydrated is also key.

dannl · · Unknown Hometown · Joined Apr 2010 · Points: 0
chris_vultaggio wrote:...have been adding a few supplements to the mix in addition to training - chlorophyll drops (closest thing in nature to hemoglobin) and blood builder pills, totally food-based.
I don't really want to rain on the supplement parade, whatever works for you, but just because chlorophyll looks like hemoglobin in chemical structure, does not mean the two molecules work the same way. Closest thing in nature = close, but no cigar. Both have a porphyrin ring, which is kind of a structure built to hold a metal ion at the center, iron for Heme and magnesium for chlorophyll. The iron in heme binds oxygen, the magnesium in chlorophyll helps shuttle electrons to other plant proteins. Chlorophyll contains no iron. Sorry, it just drives me crazy when people say chlorophyll is the plant's blood.

That other stuff "blood builder" seems a bit more worthwhile. It looks like it is processed Hydrilla plant which has a ridiculous amount of B12, which is used to make DNA, which is needed by your bone marrow to make lots of red blood cells, cause you turn them over quickly. You can get B12 from liver, shellfish or dairy, but - Hydrilla is an invasive weed in Florida, so why not rip it out of lakes and ponds, grind it up and sell it to people. Hopefully they check it for heavy metals like mercury and lead, which it can hyperaccumulate.

Or you could always eat some liver for B12 (apparently you can store several years worth in your own liver) and some green leafy vegetables like spinach or swiss chard for iron. Plus then you get chlorophyll straight from the source. :)
kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608
Ben B. wrote:Have any local 10,000'+ peaks you can hike sometime in the week before your next Alps adventure?
No - the highest are about 4000 ft.
And those are not very interesting from a skiing or climbing perspective.
So the idea of driving several hours to one of them -- then sleeping out on top for a very cold night to get maximum stimulation -- and driving back again -- doesn't seem like a very effective use of my time and money.
Acetazolamide would seem to have a way better cost/benefit ratio for my situation.

Ken
Buff Johnson · · Unknown Hometown · Joined Dec 2005 · Points: 1,145

It will take a few days to adjust. No matter how you try to decipher the acid/base buffering, it's hypoxia and pulmonary hypertension relationship.

If the symptoms always led to edema, then I would be more aggressive, but it's not. I might even think about stopping diamox. It seems like it's not doing anything more than your body wouldn't naturally do in a few of days of rest at that altitude.

A couple of things to talk to your doc with would be ed meds, which have similar effect to combat pulmonary hypertension, as was originally intended for in women, and a possible sleep aid is ambien or look at timing melatonin. Ibuprofen and cough drops aren't bad thoughts either. A discussion with your doc in the first place is a good idea to relate your history and possible contra-indications.

But like I said earlier, I probably wouldn't take anything. It seems to me you're just screwing with your body for little gain as you have always compensated for the hyperventilation in a couple days. Which is normal, it's not abnormal.

kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608

I'm not any sort of medical professional, so I'm doing my best to try to understand all these terms + ideas.

Buff Johnson wrote:it's hypoxia leading to pulmonary hypertension. If the symptoms always led to edema, then I would be more aggressive, but it's not.
I looked up the symptoms of "pulmonary hypertension" in the Wikipedia -- it seems like when I go up to my selected ranges of altutude, I only experience one out of the five symptoms. I'll take your word for it that likely I'm experiencing some level of pulmonary hypertension -- but to me it seems like my symptoms and context are a much closer match for Acute Mountain Sickness.

Buff Johnson wrote:talk to your doc with would be ed meds
I'm guessing that "ed" means drugs for erectile dysfuntion, such as sildenafil. I have done some reading about that, and it seems likely that I could climb uphill say like 2% faster if I took it -- another way to improve oxygen utilization - (tempting if I were some kind of alpine racer) - but I'm not seeing how it addresses my AMS symptoms.

I guess I could ask my doctor to let me carry some sildenafil just in case symptoms of pulmonary hypertension ever became a problem for me -- but so far in about a hundred trips like this, it hasn't.

Buff Johnson wrote:A good sleep aid is ambien ...
But I've never had any problem sleeping at 10000 ft (my typical plan in the rare cases where I sleep up high at all) -- as long as I've started taking acetazolamide a couple of days ahead.

Buff Johnson wrote:It will take a few days to adjust.
Not with regard to AMS symptoms at my chosen altitude range -- Not when I take acetazolamide.
Now I believe it does take a few days or longer for other significant adaptations, but at my target altitude range those other factors don't bother me and have not gotten in the way of achieving my (admittedly limited) goals.

Buff Johnson wrote:I would think about stopping diamox. It's not ... doing anything more than your body wouldn't naturally do in a few of days of rest ...
But that effect is exactly the only result I ever wanted from taking Diamox / acetazolamide.
I guess some people do not think that's a purpose worthy of taking acetazolamide.
But it's my purpose, and my doctor understands it, and fortunately he thinks it's worthy. And lots of other doctors in the past have thought that quicker avoidance of AMS symptoms was worthy enough for them to take the time and effort to perform scientific studies to support that off-label use.

I'm guessing that your point is that my purpose is not worth the risks and potential bigger side-effects of starting to take any new drug. Which might be useful as public service announcement to other people reading this thread. But myself, I'm way past that. I've been taking acetazolamide now for like a hundred trips over twenty years.

Ken
dorseyec · · Unknown Hometown · Joined May 2009 · Points: 5

You are trying to hard. Either listen to the other people and go 5 days early and get aclimated or go talk to your Doctor. Looking shit up on wikipedia is not the same as talking to a physician, if you are that worried about your AMS go talk to someone that knows what they are talking about.... Or just do the easy way and go 4 days early.

kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608

I tried an IHE procedure with breathing Low CO2 / normal O2 at sea-level pressure. Hit me much stronger than I expected. Next time (if there is a next time) I'll try either less time or less intensity of exposure.

Simple method: I got a canister (size about 0.3 liter / 1 cup) of CO2 scrubber (I assume it's soda lime). I attached a plastic tube with a bacterial filter to it, and breathed into my mouth thru the tube, exhaled thru my nose.

My procedure was to do a cycle of 6 minutes of breathing thru the CO2 scrubber (at a rate perhaps a little faster than normal), then 4 minutes of breathing normal sea-level air (at a normal breathing rate). Repeated this cycle 6 times for an elapsed time of one hour.

Results:

  • Oximeter on my left forefinger showed displayed 99% saturation at all times thru all the cycles (until it failed to register late in the last cycle).
  • Pulse - heart rate normal variation for moving somewhat or just resting while mostly seated.
  • my feeling at the end of the hour: Exhausted.
  • feelings during the cycles (especially later): light-headed, some blurring of vision, lethargic, yawned several times during the 4-minute normal-atmosphere periods.
  • felt overall uncomfortable after the 3rd cycle -- would gladly have stopped if I hadn't planned on six cycles.

Afterward - up to 3 hours ...
  • continued to feel tired + lightheaded even after breathing normal atmosphere for awhile.
  • took a short nap.
  • went out for a walk to try to stimulate waking up more.
  • but toward the end of the walk I was feeling exhausted, so I gladly took another nap.
  • Sharon drove me to an indoor climbing gym. At last I felt good, did some sport leading of new + old routes; then a campusing workout. Felt fully recovered.

Thoughts:
  • Reminded me of a first day at 7000-8500ft a few years ago when I tried not taking acetazolamide in advance. My body does not handle acclimatization very well. My obvious interpretation now for this Low CO2 IHE procedure is that it successfully induced Acute Mountain Sickness in me.
  • CO2 scrubber -- I've seen claims that this sort of cyclinder can reduce the concentration of CO2 by a factor of over 100 times. So if normal sea-level atmosphere has 0.04% CO2, what I was breathing thru the tube might have had only 0.0004% CO2 -- which I'd guess is the partial pressure CO2 in the atmosphere only at a very high altitude, like way higher than the summit of Mt Everest.
  • I guess normally this sort of CO2 scrubber cylinder is used for _rebreathed_ air, which starts at a much higher concentration like 4% CO2 or more (depending on how many times it's been rebreathed), so the reduction from scrubbing would then be down to something like 0.01% or 0.04% CO2 -- not as radical as what I was trying.
(? Maybe next time better to reduce the intensity by including some rebreathing into the procedure ?)

Whether this really helped for acclimatization I'll get a clue in a few days when I try climbing up on skis at 7500-13000ft.
For now I can say this was definitely the least fun way to get acclimatized in advance that I've tried.

Ken
Guideline #1: Don't be a jerk.

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