Problems on high: Rising to the challenge of altitude sickness

Outside my window, snow is falling. In people like me, snow evokes a powerful urge to strap on skis or a snowboard. The good terrain, of course, lies at lofty altitudes - altitudes that cause toothpaste to erupt from the tube and many people to feel ill.

Here's the problem: As elevation rises, air pressure falls (hence the toothpaste eruptions), the amount of available oxygen goes down, and the risk of altitude sickness goes up. Most ski resorts lie at moderate altitude (about 10,000 feet), elevations that give 30 percent to 40 percent of people sickness, also called acute mountain sickness, or AMS for short.

Steven Bezruchka, M.D., author of the booklet "Altitude Illness: Prevention and Treatment" (The Mountaineers, $6.95), likens symptoms to a those of a hangover: headache, insomnia, weakness, poor appetite and nausea. Some people also notice that even mild exertion makes them short of breath, and that their hands, feet and eyes look puffy.

No one knows why, but some people are more susceptible than others. Unfortunately, you can't predict your vulnerability from sea level. And while getting into shape will strengthen your ski legs, it won't stop you from getting AMS.

The best strategy to prevent AMS is to give your body time to acclimate to lower oxygen levels. James Bachman, M.D., owner of the Frisco Medical Clinic in Frisco, Colo., recommends spending at least one night at an intermediate altitude of 5,000 to 7,000 feet before ascending further. (Check out Bachman's Web site at

Another option is to take the prescription drug Diamox (acetazolamide). It causes deeper, faster breathing, which raises blood oxygen levels. Although prophylactic use of Diamox reduces AMS 30 percent to 50 percent, side effects are frequent and include increased urination, drowsiness, tingling and numbness of fingers and lips, altered taste (of carbonated drinks) and blurred vision.

Aspirin can help prevent the most prominent symptom: headache. A 1998 British Medical Journal study found that aspirin, 320 milligrams starting one hour before arrival at high altitude for a total of three doses, reduced high-altitude headaches in people prone to them.

Some herbs can help, too. Sunny Mavor, herbalist and co-author of "Kids, Herbs and Health" (Interweave Press, $21.95), says her herb of choice for staving off AMS is ginkgo biloba. In a 1996 study, researchers gave 44 Himalayan trekkers either ginkgo biloba extract (80 mg twice a day) or a placebo. None of the ginkgo group experienced symptoms such as headache, nausea and malaise, but 41 percent of the placebo group did. Ginkgo also reduced respiratory symptoms and circulatory problems to cold hands and feet. (Caution: If you're already taking aspirin or blood thinners such as warfarin (Coumadin), don't take ginkgo without your doctor's approval.)

According to Christopher Hobbs, author of "Medicinal Mushrooms" (Interweave Press, $16.95), reishi mushroom seems to improve blood oxygenation. A study of Chinese people who climbed over 15,000 feet during a three-day period in Tibet found that reishi greatly reduced AMS. Hobbs says the usual dosage for reishi is three one-gram tablets, three times a day, or about a teaspoon of syrup a day.

Lab studies show that Asian ginseng and Siberian ginseng (aka eleuthero; not a true ginseng) may help prevent altitude sickness. These herbs also enhance endurance and help cope with stress. (Caution: True ginsengs are not recommended for pregnant women. People with high blood pressure or who take a blood-thinning medication should first consult their doctor.)

Ginger eases headaches and has been proved to reduce nausea, including motion sickness. You might want to pack some for that winding ride up to the mountains. Take it in whatever form seems most appetizing: as a tea, tincture, capsules, raw or crystallized. If you use capsules, the usual dosage is one or two 500-mg capsules up to four times a day. (Caution: Do not take medicinal doses if you have gallbladder disease.)

Here are some other tips to combat AMS:

-- Be careful with the booze. Alcohol increases urination, aggravating dehydration. Higher levels slow breathing rates, further lowering blood oxygen and making AMS symptoms worse.

-- Don't take sleeping pills, as they can also slow breathing. A bedtime bath, on the other hand, makes for a safer relaxant. Adding about 10 drops of lavender oil to the water can help unwind your muscles and your mind. If that doesn't help, try an herbal sleep aid such as valerian root, California poppy, passion flower or hops.

-- Boost your (nonalcoholic) fluid intake. You lose more water at dry, high altitudes, particularly when you're exercising. Dehydration alone can produce headache and nausea. Shoot for a minimum of 10 tall glasses a day. Carry water with you on the ski slopes.

The information in Alternatives Therapies is general commentary and not medical advice. If you have concerns or questions about a medical condition, consult a health-care professional. Linda B. White, M.D., is a freelance writer and editor. She serves on the advisory board of and is the co-author of "Kids, Herbs and Health (Interweave Press, 1998) and "The Herbal Drugstore," due out from Rodale Press in June.