Nepal is a country with some of the highest mountains in the world. Sitting on the western side of the Himalayas, and bordering with the high-altitude plateau of Tibet, a large part of the country is at elevations above 2,500 meters. A popular destination with trekkers and mountain climbers, Nepal sees thousands of tourists a year visiting the country for trekking, mountain climbing, and visiting some of the high-altitude areas to see the sights, such as Mount Everest, and the Everest Base Camp (EBC). With so many visitors to the higher regions of the country, there is a risk of some getting altitude sickness, or Acute Mountain Sickness (AMS).
Visiting Nepal for Trekking
Traveling in the Himalayas can be risky if the traveler has not prepared properly for the high altitude. When traveling to high altitudes above 2,500 meters, it is normal for the body to need to acclimatize to the lower oxygen levels at the high altitudes, and acclimatization is one of the main keys to avoiding AMS. Trekking and mountain climbing in Nepal are strenuous activities, and if one does not acclimatize properly before reaching the altitudes where they will be trekking, the risk of AMS is greatly increased.
What is Altitude Sickness?
Altitude Sickness, also known as Acute Mountain Sickness (AMS), occurs when the body is unable to obtain sufficient oxygen to allow you to breathe normally and allow the normal bodily functions. As the altitude increases, the percentage of oxygen in the air is reduced, making certain physical problems more exaggerated.
Altitude sickness can affect anyone ascending to high altitudes, and there is no defining factor to say who will get it and who will not. It can affect anyone, irrelevant of age, sex, or level of fitness, and if you have never experienced it before when trekking in high altitudes, it is still likely that you could experience it, even in similar conditions. Individual people can still experience different rates of acclimatization on different trips, even where the conditions are identical to previous visits. On average, most people with a reasonable level of fitness can ascend to around 3,000 meters with little or no problems. However, every year trekkers spoil their holidays because they did not listen to the signs of AMS in their bodies.
When traveling to high-altitude regions, the body needs time to adjust to the change in oxygen levels. In order to counter the reduced amount of oxygen in the air, the body produces more red blood cells to carry more oxygen around the body to provide what is needed, especially to the muscles and brain. Ascending too quickly to higher altitudes means that the body does not have time to make its internal adjustments and the body starts to suffer from oxygen deprivation. Acclimatization takes time, and while you may feel fine when you reach the higher altitudes, it is useful to know that the symptoms of AMS take a little time to show themselves as well. Normally, symptoms of AMS with start to show up after the first 10-24 hours, if the body has not had time to properly acclimatize.
Symptoms of AMS (Acute Mountain Sickness)
Altitude Sickness can attack in three main forms. Acute Mountain Sickness (AMS) is the mildest form of altitude sickness, and symptoms normally include: Headache, Dizziness, Fatigue, Shortness of breath, Loss of appetite, Nausea, Disturbed sleep, General feeling of malaise.
Experience Symptoms of Mild AMS
Mild altitude sickness can feel terrible, but it can be easily treated, if caught early. One of the main things to remember when trekking in high altitudes is to know and recognize the symptoms, and let someone know how you feel. Rest and rehydration are recommended to help counter the effects of AMS, and as long as you do not over-exert yourself, and take a day or two of rest, the symptoms normally subside as the body becomes more acclimatized.
All or some of the symptoms given may present themselves in mild cases of AMS, however, they can worsen rapidly if not taken seriously and treated, and this can be severely debilitating, and even fatal.
Altitude Differences in Nepal
Nepal is a country of changing altitudes. With several different climate and topographical variations in the country, altitudes in different parts of Nepal vary greatly, and where you could be fine at one altitude, you may experience symptoms of mild AMS at others. The climate in Nepal can be separated into six different zones, which from lowest to highest are:
The tropical zone below 1,000 meters (3,300 ft)
The subtropical climate zone from 1,000 to 2,000 meters (3,300 to 6,600 ft)
The Temperate climate zone from 2,000 to 3,000 meters (6,600 to 9,800 ft)
The Subalpine zone from 3,000 to 4,000 meters (9,800 to 13,100 ft)
The Alpine zone from 4,000 to 5,000 meters (13,100 to 16,400 ft)
The Transhimalayan climate zone, above 5,000 meters (16,400 ft)
From the area of the Subalpine zone upwards, there is an increased likelihood of AMS, and at the Transhimalayan zone it is highly likely if you have not acclimatized properly, although in some cases, even acclimatization is not sufficient, and you will need to descend quickly to below 3,000 meters.
For such a small country, the geographical diversity of Nepal is tremendous. At its lowest point, in the tropical Terai area, it is as low as just 59 meters above sea level. As the geography changes, so does the altitude. The Terai area is the flat, lowland country starting at the Indian border, which increases in elevation over the lower foothills to the Pahad area, a mountain region that does not normally contain snow. The Pahad area begins at the Mahabharat Range, where the escarpment rises dramatically to around 2,700 meters.
The Pahad ends when the ridges begin to rise substantially over 3,000 meters, to the Himal region. Himal is an area of mountains that contain snow, where ridges rise to as much as 5,500 meters. The final region is the Trans-Himalayan region, which is the area of the Himalayas that edges into the Sino-Nepal border with Tibet. Here, the valleys can be as low as 4,500 meters, but the ridges and peaks reach over 5,500 meters.
Avoiding AMS in Nepal
Symptoms of AMS often manifest between 6-10 hours after ascent, although it can take as long as 24 hours to show any signs of AMS. Symptoms will normally subside in one to two days if rest and rehydration occurs, but this can occasionally develop into more sever conditions. Do not climb or walk any higher when you have symptoms of AMS, and even consider reducing your altitude to aid in recovery.
The body takes a few days to properly acclimatize to high altitudes over 3,000 meters, so a couple of days acclimatizing when you reach your destination will help to prevent AMS during your holiday or trek.
Avoid Strenuous Activity
Strenuous activity increases the risk of AMS, and can even induce the symptoms, especially if you are not properly acclimatized. If you do experience symptoms that cause any discomfort, rest and reduce your altitude by riding instead of walking. If walking to a lower elevation is the only option, reduce the weight you carry and walk slowly to prevent yourself from over-exertion.
Dehydration is one of the main reasons for AMS in trekkers, and being dehydrated, even slightly, can exacerbate the symptoms of AMS. Consume sufficient water to allow the body to remain hydrated at all times, and avoid alcohol, as it causes extreme dehydration. Ensure you have a light salt intake through food, not drinks, and rehydration powders are a useful resource.
Avoid Dramatic Increases in Elevation
Any treks at high altitude should avoid big, single-day increases in elevation. it is best to ascend slowly, no more than 300-400 meters per day. A common cause of AMS in trekkers is the misconception that fitness can dictate the body’s ability to fend of the symptoms of AMS. This often causes people who are in good physical shape to ignore the rules of acclimatization, and go too high, too fast, causing serious problems. Keep the pace even, rest regularly, and always rehydrate.
Your body has to work harder at higher altitudes, so energy replenishment is more important. Make sure you stay nourished by eating high protein and carbohydrate foods. Snacks are a good way to stay energized on the trail, and things like chocolate, nuts, dried fruits, and biscuits are high in energy and calories, to help you stay on top.
Listen to Your Body
By following a few simple rules like those here, you can greatly reduce the chance of being affected by the symptoms of AMS. However, everyone reacts differently to high altitudes, so you need to pay close attention to your body, and how you feel. What may feel like a little headache or just feeling tired could be the first symptoms of AMS. Around 75 percent of people feel some effects of altitude, mainly in the form of fatigue, headaches, nausea, and sleeplessness. These mild symptoms should not interfere with a normal activity on your trek, but be aware if the symptoms start to feel worse than very mild. If more severe symptoms occur, move to a lower elevation immediately.
Medications for Altitude Sickness
The only real treatment for AMS is to descend to a lower elevation, but there are some drugs that can help with the symptoms. For symptoms such as headaches and nausea, Ibuprofen can help to treat them. Diamox (Acetazolamide) is a respiratory stimulant that can help the body to metabolize oxygen more efficiently. This medication can decrease headache, tiredness, nausea, dizziness, and shortness of breath that can occur when you climb quickly to high altitudes, generally above 3,000 meters. However, Diamox also has its own side effects that can feel similar to the symptoms of AMS, and can often confuse the person into thinking they have AMS symptoms, when it is only the side effects of Diamox.
You should always consult a doctor before taking any medication, especially for something as serious and potentially fatal as AMS. However, to majority of ordinary tourists, there is no need to worry about altitude sickness while traveling Nepal. The all our Nepal tour itineraries are safe enough for our clients to handle, not like those what professionals adventurers do such as climbing Mt. Everest, etc. Making sure the safety of our clients is one of our top priorities.
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