this is your body on altitude - #22

Send oxygen.

This pile of logs sits just shy of 10,000 feet. In the grand scheme of things, it’s not that high. Go to Bolivia, Colombia, Nepal, and many other countries that are not the United States and you will find millions of people who live above 10,000 feet. It’s not that Americans can’t live that high — it’s that we don’t really have very many options to. If you want to live above 10k in the States, your options are four small towns in Colorado. And I mean small. The only place in the US that sits over 10,000 feet with more than 1,000 people is Leadville, Colorado. Now obviously you can go out and pitch a tent as high as you like (sort of, permits allowing) but grocery accessible? Not many options.

We considered the altitude when looking for a home, but more from the standpoint of how long exactly will it take to feel normal again? Historically, I have not been great with altitude. When I would attempt to exercise at my parents’ house at 5,000 ft, I was notably slower, out of breath, and while I can’t attribute causation but will note high correlation, I was super irritated about it. Hiking to my dad’s old lookout at 7,600 ft had me absolutely huffing. So, you know, I had my concerns about moving here. Let’s take a look at my history with elevation, or my personal mountain range. 

This chart covers each year of my life and the elevation I spent it at. 

Hmmm… what does this chart remind me of…

As you can see, I grew up at 1,214ft. Then I went lower and lower ‘til I lived at, well, 0 feet because it was a boat. I spent one year in Boulder (the notable spike), back down to nearly sea level in Santa Monica, and then comfortably out of the tsunami zone in Topanga at around 1000 ft. Then, it went up — my own personal elevation variant. And I felt it.

“Feeling” altitude

So what does feeling altitude mean? It depends — on you, your health, how you got to that altitude, and what you’re doing there. 

First, let’s break down what the issue is: our friend air. The majority of each breath we take is around 79% nitrogen and 21% oxygen. This doesn’t change at altitude. We’re breathing the same air up here. 

What does change is the pressure, or how many molecules of oxygen are in the volume of air. Barometric pressure at sea level is 760mmHg, but at 10,000 feet, that goes down to 534mmHG. Essentially, the volume of air coming into your lungs has the same ratio of oxygen to nitrogen, there’s just less of it. At 14,000 feet, the air has 43% less oxygen than at sea level because there’s less pressure to “smoosh” those molecules together. You’re taking in the same volume of air, your lungs are the same size meat pockets they were before, it’s just that when you fill them up, it’s like filling the car with watered down gas. You can fill the tank all you want but that gas station is still ripping you off. 

But as mentioned above, plenty of people live where the oxygen molecules are like “I need my space.” And they live well because of a process called acclimatization. A lot of things happen when you head to the high country:

1. Your body has to adjust to the oxygen, and so you might feel short of breath. Climb a flight of stairs on day one and it will feel like you’re climbing a mountain. You will breathe faster and deeper, and this does increase the oxygen content in your blood, but not to the same levels it would be at sea level. Oxygen tanks are a temporary reprieve. 

2. Your heart rate goes up. In order to get oxygenated blood to your body, your ticker is gonna be cracking the whip. This goes down over time, but those first few days your heart is working, baby. 

3. You pee more. This is a response to changes in acid/base balance in the body. 

4. You get headaches. (There’s some debate about why this is, but lack of oxygen, peeing a lot, body stress, blood vessels swelling, etc., all seems like a pretty good combo to make your head hurt.)

5. You can’t sleep very well. That low oxygen can really fuck with the sleep center of the brain. You might wake up a lot, and just have general shitty sleep. It gets better over time, usually. You can take sleep medications like Ambien and Lunesta, but avoid the benzos because they decrease your “breathing drive.” 

So it’s basically a hangover, and it shares a similar aid: drink more water.

At elevation, you’re experiencing two types of water loss. 

• “Sensible losses” like peeing and sweating, things you can measure

• And “Insensible losses” like moisture evaporating from the skin or moisture lost during breathing

And since your body is working pretty hard and breathing pretty hard, well, you’re losing water hun. Let’s look at what that means for cyclists, because I’m biased. This paper took a look at athletes’ fluid requirements at altitude and found that each athlete’s need could increase from 29 additional ounces to 64 oz, just lost through breathing and peeing. That’s almost two liters! You thought you were peeing a lot before, just wait. 

Before you’re like, “I’m not a pro cyclist,” just know that the Institute for Altitude Medicine suggests regular visitors also take in an additional 1 to 1.5 liters of fluid per day while at altitude. But, ya know, don’t guzzle it or you could end up with hyponatremia: the dilution of sodium in the blood caused by excessive drinking. Guess what the symptoms are? I’ll give you a hint: they’re almost identical to altitude sickness. So let’s get into that. 

Altitude sickness

Altitude sickness, sometimes known as mountain sickness, starts to occur typically above 8,000 feet, but as we’ve covered, you can begin to “feel” the altitude lower than that. Some people can experience altitude sickness as low as 6,000 feet. That includes places like Colorado Springs, Flagstaff, Durango, and pretty much every ski town (Taos, Aspen, Breck, Park City, Jackson, etc.)

According to the Institute for Altitude Medicine, somewhere between 15 and 40% of visitors to Colorado sleeping at 8,000 ft or higher get AMS, most of them at ski resorts. You can help improve your odds by spending one day in Denver before coming up to elevation, but who’s got the vacation time for that. The first sign of altitude sickness, or acute mountain sickness (AMS), is a high altitude headache. But to actually be diagnosed with AMS, you’ve gotta have the other symptoms too: loss of appetite, throwing up, weakness, dizziness, fatigue, aka a hangover. And you can start feeling these symptoms as soon as two hours after arriving at altitude or not until about a day later. Of note though: these symptoms don’t develop after two days of feeling fine unless you’ve increased elevation even more. If these symptoms kick in after a couple days at the resort, it’s not the mountain, it’s the margaritas. 

There are a few thing you can do to improve your chances of feeling good:

• Drink water

• Take your time getting to altitude to give your body a slower, easier acclimation

• Go easy on the alcohol and benzos because they suppress breathing

• Take Diamox a day before coming and for the first two days you’re at altitude. Supposedly it’s pretty effective in preventing AMS by stimulating breathing, raising blood oxygen, and increasing urination. Fun. Get an aisle seat!

And here a few ways in which you might be gently fucked by the thin air, i.e., what increases your chances of getting AMS:

• Your genetics, lol

• Living below 3,000 feet

• Obesity

• An existing respiratory infection 

• Going too hard the first two days

• Drinking alcohol the first night

The good news is AMS is very treatable, especially by just going to a lower elevation. It even resolves itself after spending time at the same elevation (but, obviously, do not go higher. As the saying goes, “Don’t go up til the symptoms go down.”)

Some other altitude illnesses to know about are High Altitude Cerebral Edema (HACE) and High Altitude Pulmonary Edema (HAPE). HACE is real bad AMS. With AMS, you get a little brain swelling, with HACE you get more, but also all the symptoms of AMS with the addition of confusion, lack of coordination, seizures, coma, and eventually death if untreated. How do you know if someone has HACE? They seem drunk without drinking. Also you’re probably over 13,000 feet. If you’re going that high, acclimate at lower altitude first, take your time going up, drink more water, easy on the booze, and take some Diamox.

And if you’re experiencing it or are with someone who is, get down to a lower altitude and get medical attention. If you’re stuck because of weather or injury, you can use a Gamow bag or other hyperbaric bag. I’m sure you have one — they’re only $2600. Ha, ha.

But the real baddie is HAPE. HAPE is when you get fluid in the air sacs of your lungs from leaking capillaries — pleasant! Blood pressure in the lungs goes up in response to the lack of oxygen, and some of the blood vessels can’t manage the high pressure, so they leak, messing up the exchange of oxygen in the lungs, which can kill you. Symptoms start gradually, as benign as shortness of breath, but as the fluid builds up, it can lead to a persistent cough (sometimes bloody), chest congestion, and severe weakness. If you feel like this, you should get help no matter what it is. 

Good news is, it’s estimated in the US that only 1 in 10,000 skiers gets HAPE, and they’re typically so close to medical care it doesn’t kill them.

This is a fun newsletter topic, isn’t it? 

So what increases your likelihood of HAPE?

• Again, genetics. Fun.

• Certain lung and heart conditions

• High pulmonary artery pressure

• Being a guy (sorry men, it’s more frequent in y’all than women)

• Coming to high altitude with a respiratory infection (please don’t do that regardless)

If you get HAPE, get your ass to a hospital. 

Living at altitude

We’ve been here for 6 months or so now, and my first phase of acclimation is well over. But when we visited this area, coming from sea level, we went on a 15-mile hike that traversed a pass at just above 13,000. And guess who started to show symptoms of HACE? We were just shy of the pass, and I couldn’t understand a thing Ben was saying. I could tell he was talking, but my brain was like, “sorry, babe. I’m like, super swollen and processing power is real low.” My video game avatar was on her last health bar. I told Ben immediately. And he held my hand as we took it very slowly, finishing the final 200 feet of the climb before descending down the other side into thicker air. 

When I was at my worst and Cooper was like, “Are you gonna hurry up?”

I share this because if you’re like “I’M GONNA DIE OF HACE IF I GO TO COLORADO!” the reality is you’re probably not. It was easy for me to feel the shift from my typical bouts of AMS to something more worrying. And we addressed it (somewhat) immediately. 

Two months after living here, I attempted a solo hike up to the same elevation and had to turn around. The final climb this time wasn’t a mellow-graded popular trail — it was a technical however-you-can-get-up-it scramble. And I didn’t have it in me. I felt weak and lethargic, my head was hurting, and nausea was creeping in. I turned around to get to a lower elevation. By 11,500, I felt fine, and even jogged most of the way home.

While the headaches have gone away and I sleep well again, it still takes two years to fully acclimatize, according to Sarah Baysden, director of Western State Colorado University’s High Altitude Performance Laboratory. And where I feel this the most is working out. My poor muscles just don’t get the same amount of oxygen they did at 0 feet. In fact, your VO2 max drops 3% for every thousand feet of elevation gain, starting at around 5,000ft. Which means my max has dropped 15%. I wasn’t very fast before, but now, yeesh. 

But y’all, there are benefits. 

“The available data indicate that residency at higher altitudes are associated with lower mortality from cardiovascular diseases, stroke and certain types of cancer.”

Nice.

“In contrast mortality from COPD and probably also from lower respiratory tract infections is rather elevated. It may be argued that moderate altitudes are more protective than high or even very high altitudes. Whereas living at higher elevations may frequently protect from development of diseases, it could adversely affect mortality when diseases progress.”

Oh, dear. I’m in the “high altitude” category, which is 2500-3500 meters. 

It’s sort of hard to prove this is altitude’s fault. A lot of people who live at higher altitudes just lead more active lifestyles and thus are healthier. But this story took that into account. You’re really less likely to die from cardiovascular diseases here, but if you do develop one, it’s gonna suck.

Plus, at this elevation, the body is producing more red blood cells and more of the enzyme that facilitates the release of oxygen from hemoglobin to body tissue. We’ve also got decreased air pollution, but a notable increase in UV radiation and burning the shit out of your skin wearing a tank top outside for ten minutes. 

But there’s more! And this one is a little odd.

When we first moved here, it was impossible to ignore how slender everyone was. And I mean lean. Everyone is ripped and lean. My first thought was “oh, great, everyone in town has the Sarah Connor arms I want and cannot motivate myself to actually get. Lovely.” But six months in with no lifestyle changes, I’ve lost 5 lbs. Why?

Part of it is that your body is working harder. Your heart, your lungs, it’s almost like you’re always exercising. But another component is that appetite decreases at elevation. This is common in climbers attempting long summits, and so some researchers were like “what happens if you take the hard part out?” So they simulated the 40-day ascent to Everest in a hypobaric chamber. The participants had plenty of (supposedly) good food to eat, but they just weren’t that hungry. Which means the findings suggested that hypoxia (less oxygen) alone could cause weight loss. Your brain and lungs are like, “if we can’t have oxygen, it’s only fair the stomach doesn’t get food.”

Point being, you don’t even have to exercise to lose weight here. Another study took “sedentary males” (lol) to a high altitude where they were allowed to eat as much as they wanted, but on average they ate 730 calories less than they usually did at a lower altitude. They also showed increased levels of leptin, the protein hormone playing the leading role in metabolism. So the participants not only lost weight, but kept most of it off when they went home. 

I’m actually, for the first time since moving here, very hungover while writing this. I had four drinks last night, stopping at about 11pm, and I woke up at 5am to take two Advil and a drink a glass of water with electrolyte mix. My Whoop says I am 16% recovered so I’m sitting on the floor writing this with a box of Triscuit, where I belong. It feels like an achievement of acclimating to even be able to drink that much at this elevation. My Whoop also tells me my blood oxygen level is typically in the low 90s here. Earlier this week, it read as low as 89%. That same day, I went to the medical center for a yearly physical and their reading of my blood oxygen was 97%. I trust them more than a piece of plastic on my wrist, but either way, I have become more intentional about breathing after years of anxiety leading to chronically short and shallow breaths. My respiratory rate has increased after living at sea level, and I’m genuinely excited for an upcoming trip to the lowlands to see how this is impacted. 

Not me having this picture of myself framed.

After 6 months, going up to 13k is still a challenge, but I don’t experience AMS. I feel strong here now, my body feels more like a machine because it has to. It has to be economical and efficient because living at elevation is harder on your body. But it also makes harder bodies. Maybe you’re into that, maybe you’re not. All I can say is that with 1.5 years left for full acclimatization, so far, so very, very good.