What’s the Deal with Altitude Sickness in Peru, and How to Avoid It?
Want to know about altitude sickness in Peru from someone who spent 10 years guiding there? This blog shares my personal experience, advice on what to expect, and preventative measures you can take for yourself and your clients.
What’s the deal with altitude sickness in Peru,
and how to avoid it?
I spent the better part of ten years living in Cusco and guiding hundreds of visitor through the Andes. The people I guided came from all walks of life, were of all ages, and spanned every fitness level from “never been hiking and have two knee replacements” to “I run a marathon every other week.” So, I’ve personally experienced about all that can be experienced when it comes to travelers dealing with the challenges of altitude in Peru.
Altitude issues in Peru is a major worry for most first time visitors, and “how will altitude affect my trip/affect my client’s trip” is the the most frequently asked question I receive. This blog shares my personal experience, advice on what to expect, and preventative measures you can take. But do note that this is not from a medical professional’s point of view, but from a practical sense as experienced during my years of guiding.
First, most people ask, “will I get altitude sickness?”. The straight answer to that is, “I don’t know, and neither will you, until you are there.” I’ve had guests as young as 3 and as old as 83 on trips, age doesn’t seem to matter. I guided an ultra-marathon runner who was used to running up to 120 miles at a time, ate a perfect natural diet and he was utterly destroyed from arrival until departure with altitude sickness. On the other end, I’ve guided many “party dudes” who insisted on lighting up a cigarette and seeking out a beer the moment they disembarked at Cusco’s 12,000ft rarified altitude, and suffered no ill effects whatsoever. So really, altitude sickness is indiscriminate, and effects every single person differently. You’ll never know how you fare until you get there.
But that doesn’t mean you should pour yourself a snifter of brandy, light up a cigar and leave it in the hands of the Pachamama. There are certain things you can, and should do, prior to your trip, and during your trip, to “stack the deck” in your favor. Let me elaborate on a few of them:
1) Intelligent itinerary design.
Just as people who climb Everest make their ascent slowly, and incrementally increase their altitude over time, a well-planned itinerary in Peru should do the same. Start low and end high. The graphic below from Inkaterra is an excellent one which shows the major points of interest in Peru and their respective altitudes. Here are the main visitor sites in ascending order:
Lima: Sea Level
Amazon: 600ft (183 meters)
Machu Picchu: 6,627 feet (2020 meters)
Arequipa: 7,600 feet (2,315 meters)
Sacred Valley: 9,776 feet (2,980 meters)
Cusco: 11,152 ft (3,400 meters)
Lake Titicaca and Puno: 12,500 feet (3,810 meters)
Since most everyone coming to Peru will be visiting Cusco, the Sacred Valley and Machu Picchu – let me use that as an example. To get to Machu Picchu (which people are always surprised to learn is actually quite low in elevation and in the subtropical cloud forest) you must fly from Lima at sea level to the airport in Cusco at 11,100 feet. This is a huge jump in altitude in just a one hour flight. It’s generally not the best to land and sleep in Cusco as a first stop. It’s better to land in Cusco, and then get down to Machu Picchu at 6,600 feet by vehicle and train in one day. Or arrive in Cusco and take the one hour drive into the Sacred Valley to spend your first few nights at 9,776ft which is much easier to acclimate at than at the height of Cusco. It puts less strain on your body. For every thousand feet of increased altitude, the amount of oxygen in the air decreases exponentially, thus increasing the likelihood of experiencing altitude sickness. This is especially true after crossing 10,000ft elevation. So head first to Machu Picchu or the Sacred Valley, then come back to enjoy Cusco once your body is better acclimated from the time spent at a lower elevation in the Sacred Valley and Machu Picchu.
As another alternative, you could choose to make a stop in Arequipa or go to the Amazon basin as a first stop on your trip before tackling the higher elevations. And if you plan to do Lake Titicaca, make sure you do this as a last stop on the trip as it is one of the highest places most visitors to Peru go and the one where people are more likely to have issues.
2) The First 24 Hours is Vital
I know people are excited to land and hit the ground running in this beautiful and exotic destination, but if you can, force yourself to build in a rest day without anything planned on the day you arrive at altitude. It’s the single best thing you can do for yourself and will set you up for a wonderful trip in the days ahead. When confronted with altitude, your body must work extremely hard to build up more white blood cells to carry more oxygen. So let your body do this and don’t put any additional strain on it than absolutely necessary. Get to where you are going, and lay down to read a book, take a nap, watch some TV, or whatever, so long as you are moving your body as little as possible.
The air at elevation is also quite dry and your body needs to be hydrated to build up the white blood cells. Drink a TON of non-carbonated, non-alcoholic and non-caffeinated beverages in the first 24 hours and keep the intake up the whole time at altitude. You’ve probably heard of drinking “Coca Tea” in Peru, and yes it is good. I personally don’t think you are getting any therapeutic magic from the Coca leaves in acclimating, but it is a non-carbonated, non-alcoholic, and non-caffeinated herbal tea, so give it a try. Ultimately you are hydrating with it. Also your body digests food a lot slower at altitude, so digestion takes away energy from your body that it needs to acclimate. So eat small light meals that are easy to digest that first day and make sure to eat several hours before trying to sleep; a bowl of soup is perfect. If you can force yourself to do nothing the first 24 hours, drinks tons of liquids and eat light – you are doing the best thing possible to set yourself up for success, not just initially but for the entire trip. If you overexert yourself, drink alcohol and eat a huge meal – you are going to feel it, and it’s going to set you back in a major way on the road to acclimation.
3) Shall I consider taking altitude medication?
I’m not a medical doctor, but in my ten years guiding visitors at altitude in Peru I had way more negative experiences with people who arrived taking these medications than positive ones.
There is a prescription medication called Acetazolamide (brand name Diamox) that has proven effective for many at altitude. But this medication was not made for altitude, it was made for treating glaucoma. Here is why I don’t like it from a guide’s perspective: First, you need to start taking it a few days before you arrive at altitude and need to keep taking it. So you never really know or learn how your body naturally responds to altitude. Second, the medication is a diuretic, so it’s counter productive in one sense that you are trying to keep your body hydrated, but taking a medication that is making you urinate more frequently. And third, the biggest drawback I saw with many people is that there are a lot of strange side effects that the medication can produce. The main ones being tingling in the extremities, lightheadedness, and a weird metallic taste to carbonated beverages. These uncomfortable side effects often make people hyper aware of their body and thus produce anxiety for them, and make it impossible to determine if these sensations are because of the altitude, or in reaction to the medication.
If you have been to altitude before and know that your body has a terrible time with acclimating, then that is the one scenario where I think trying Diamox is a good idea. But for anyone else, building in time to acclimate naturally is the best course of action.
4) What about oxygen supplements?
There are a few hotels that market that they have “oxygen enriched” rooms. This is great if you plan to stay in your hotel the entire time while in the Andes, but is counterproductive to allowing your body to acclimate naturally if you are sleeping in a room full of additional oxygen.
Every hotel in the Andes generally has oxygen bottles at the reception desk and most tour companies have oxygen bottles in their vehicles too. These are used if someone is feeling very ill at altitude, are dizzy, can’t catch their breath or have a racing heart rate, often from overexertion on arrival. The treatment is to provide oxygen therapy of 10-15 minute increments as a boost, not to keep the mask on for hours at a time.
In summary, don’t worry about Altitude too much and certainly don’t let it put you off from coming to Peru. Millions of people every year come and very few have major issues. If you have the right itinerary planned, and take the precautions mentioned here, you are sure to have an amazing time.
Here below is a perfect itinerary in Peru, taking altitude into consideration, and staying at Inkaterra’s properties:
Day 1: Arrive Lima and overnight
Day 2: Fly from Lima to the Amazon in Puerto Maldonado to stay at Inkaterra Reserva Amazonica or Inkaterra Hacienda Concepcion.
Day 3: Excursion in the Amazon
Day 4: Excursions in the Amazon
Day 5: Fly to Cusco, drive to Ollantaytambo and take the train to Machu Picchu, staying at Inkaterra Machu Picchu Pueblo Hotel.
Day 6: Spend the morning enjoying the free activities on the hotel grounds of Inkaterra Machu Picchu Pueblo Hotel (tea plantation, orchid garden, bird watching, the spectacled bear project, etc) then head up to Machu Picchu after lunch around 2pm. There are far fewer people in the afternoon than in the morning, and the light is glorious. Sunset is often more spectacular than Sunrise in my experience. Spend a second night at the Inakterra Machu Picchu Pueblo Hotel.
Day 7: Take a morning train from Machu Picchu to Ollantaytambo in the Sacred Valley. Tour the Sacred Valley and overnight at Inkaterra Hacienda Urubamba.
Day 8: Additional day exploring the Sacred Valley and staying at Inkaterra Hacienda Urubamba.
Day 9: Drive to Cusco in the morning and explore Cusco and surroundings this afternoon. Overnight at Inkaterra La Casona.
Day 10: A full day exploring Cusco and a second night at Inkaterra La Casona.
Day 11: Fly back to Lima and depart, or extend your trip at this point to visiting Lake Titicaca and staying at Titilaka.
Trains, Planes & Automobiles: How to Access Lake Titicaca
Lake Titicaca is now more accessible than ever thanks to new train routes linking Cusco, Puno and Arequipa. To help guests navigate the multitude of transportation choices, Titilaka has compiled a helpful pdf outlining all access options for travelers arriving from Bolivia or within Peru.
Lake Titicaca is now more accessible than ever thanks to new train routes linking Cusco, Puno and Arequipa. To help guests navigate the multitude of transportation choices, Titilaka has compiled a helpful pdf outlining all access options for travelers arriving from Bolivia or within Peru. The pdf, featured in their latest newsletter, is geared towards travel-industry insiders but does not mention rates and therefore can be sent directly to clients who are considering Lake Titicaca and Titilaka. Download a copy of the PDF here.
Trains:
On May 31st, 2017, PeruRail relaunched the Titicaca Train which links Puno to Cusco on a 10 hour and 33 minute luxury rail trip. Passengers travel through spectacular high altiplano scenery in Pullman-style train cars with a capacity for 132 persons. The train travels from Cusco-Puno on Wednesdays, Fridays and Sundays and from Puno to Cusco on Mondays, Thursdays and Saturdays. No stops are made, though travelers can take in the scenery from the Observatory/Bar car while enjoying traditional live music and dancing, three gourmet meals, assorted beverages and afternoon tea. This is an excellent option for train buffs looking for a more relaxing day after the excitement of already touring the Sacred Valley and Machu Picchu but due to the length of travel and lack of stops, is not recommended for children. More information on the journey and services can be found on the PeruRail website.
Andean Explorer Train Route in Detail
The Belmond Andean Explorer began service this year, offering the first ultra-luxury Sleeper Train experience in South America. The train runs between Cusco, Lake Titicaca (Puno) and Arequipa with regularly scheduled weekly departures for every month except February and unlike the Titicaca Train, passengers disembark on short, guided explorations along the route. Currently, travel options include either a 3-day/2-night journey connecting Cusco to Arequipa (with just a day-long stop at Lake Titicaca) or as a 1-night/2-day journey between Cusco and Puno. While PeruRail manages the bookings for the Belmond Andean Explorer, in-depth descriptions of the routes and sleeper cars can be found on the Belmond website.
Planes:
Flying continues to be the quickest and most convenient way to reach Lake Titicaca. From Lima, LATAM and Avianca offer a total of four nonstop daily flights to Juliaca, the closest airport to Puno and Lake Titicaca. Nonstop flight time is just under two hours. Many more flights connect via Cusco and the Cusco-Juliaca leg of the flight takes just 40 minutes. While codesharing makes it possible to book onward travel to Juliaca after an international arrival into Lima, this really isn't recommended due to the high altitude of the lake of 12,508' asl. Better to first acclimate in Cusco, the Sacred Valley and Machu Picchu and then proceed up to Lake Titicaca.
Titilaka offers complimentary pick-up for all guests arriving at the Juliaca Airport. The cultural experience begins right away as a brief stop is often made at Sillustani, a large complex of Pre-Hispanic tombs located about halfway between Titilaka and the airport.
Automobiles:
Private car transfers can be arranged to Lake Titicaca from Arequipa, the Colca Canyon, Cusco and the Bolivian Border and travel times range from 2-7 hours without stops. There are also a number of 'tourist bus' companies that offer First Class service between Arequipa and Puno or Cusco and Puno. Timing ranges from 7 hours with direct travel to a full 12 hours if the bus makes stops along the way. While there generally isn't much overlap between guests who stay at Titilaka and travelers who opt to go overland by bus, its still a viable transportation option to be aware of.
Titilaka includes complimentary guest pick-up at either the Puno rail station, Puno bus station or Juliaca Airport and can arrange overland transportation from Bolivia or Arequipa upon request. Private touring en route can be arranged as well if requested in advance.
Titicaca..much more than a funny named lake.
Standing on the shoreline of Lake Titicaca in the brilliant morning sun, it’s the scale that overtakes your senses. Nestled amongst snowcapped 20,000-foot Andean peaks, the lake itself is a vast expanse of impossibly blue water. It measures a staggering 118 miles by 50 miles. With an average depth of 351 feet it is South America’s largest lake by volume, while also being one of its highest at 12,507 feet.
Titicaca...much more than a funny named lake.
Standing on the shoreline of Lake Titicaca in the brilliant morning sun, it’s the scale that overtakes your senses. Nestled amongst snowcapped, 20,000 foot Andean peaks, the lake itself is a vast expanse of impossibly blue water. It measures a staggering 118 miles by 50 miles—larger than the combined landmasses of Rhode Island and Connecticut. With an average depth of 351 feet it is South America’s largest lake by volume, while also being one of its highest at 12,507 feet.
A man from Isla Taquile, in traditional dress, looks across at the sister island of Amantani.
I’ve been traveling to the Peruvian side of Lake Titicaca for the better part of two decades and it is precisely the incomprehensibility of the place that keeps me coming back. The ever-unfolding visual feast is just the beginning; the lake’s remarkable dimensions are rivaled only by the depth and breadth of its cultural significance in the expansive history of the Andean peoples.
Pre-Incan/Pan Andean
Justifiably, when most people think of Peru, they immediately think “Machu Picchu.” I get it; it’s a breathtaking, bucket list-worthy destination, but it’s also the tip of the iceberg. That’s because, in the grand scheme of pre-Columbian history, the Incan Empire was itself a brief but brilliant flash in the pan. Built just a few years after the beginning of the culture’s scant, 100-year reign, Machu Picchu was a Hamptons-esque estate built for the ruling elite just outside the capital city, Cuzco.
Titicaca, by contrast, is where it all began for the Incas. It’s the setting for their origin myth; the creator god Viracocha emerged from the lake’s depths, commanded the sun, moon and stars to rise and then wrought the first human man and woman from stone. The Incans also believed their souls would return to the lake’s sapphire depths to rest for all eternity.
The human history of the area began eons and eons before the reign of the Incas, though. Archeologist estimate that it was first settled sometime between 10,000 and 8,000 B.C.E., making it quite literally a cradle of civilization on the South American continent.
The cultural landscape we see at the lake today is incredibly complex precisely because it has been slowly unfolding for millennia. As with all human stories, the plot hits the big beats (enough conquest, subjugation, alliances and upheaval in quantities to make Game of Thrones look like a children’s book). However, what’s really remarkable about Titicaca is the way in which extreme diversity manifests in such close proximity.
Islands Apart
Ask anyone who has visited Titicaca for highlights and inevitably the Uros are at the top of the list—and for good reason. The otherworldly network of roughly 40 floating islands are made entirely of the native totora reeds, which grow in abundance on the shores of the lake.
The more than 2,000 members of the Uru ethnic group who live on the islands are culturally distinct but speak Aymara, the language of the predominant mainland people. Both cultures preceded the Incas, and despite having been conquered by the empire, retained elements of their (somewhat) shared identities.
By contrast, the inhabitants of nearby Taquile Island still live by the traditional Incan moral code: ama sua, ama llulla, ama qhilla ("do not steal, do not lie, do not be lazy") and to this day speak Quechua, the official language of the Incan empire.
Linguistically, Quechua and Aymara are not even in the same family. This means that people who are essentially neighbors literally cannot understand each other—and haven’t been able to for thousands of years. As a result, occasions for interaction, local markets for example such as the one in Acora, are rarely dull affairs. In an explosion of colorful, dramatically different traditional dress, vendors hawking colorful, dramatically different goods pantomime their way through transactions with patrons. It’s exciting, entertaining and wildly inefficient, but everybody’s just kind of OK with that.
Opposites Interact
In a place where so many cultures have intersected, embracing difference rather than subsuming it is key to keeping the peace. In fact, you could say that duality is the rule, not the exception here. This is a fundamental concept in Andean cosmology—Ayni—which relates to the need for a balance of opposites in the universe.
In order to experience the living embodiment of Ayni, it’s necessary only to travel a short distance from Taquile to Amantani. The boat ride, less than a mile, can feel like a passage through a portal into an inverse universe where everything is suddenly the opposite.
The islanders share a common language and Incan heritage, but Taquile is a patriarchy, Amantani a matriarchy. On the former, men govern the community and head families. They also knit clothing and textiles recognized by UNESCO for their quality and cultural importance, leaving virtually all other work on the island to the women. On Amantani, that dynamic is flipped: women make the decisions and manage the day-to-day governance of the island while men labor in the fields. The inconsistencies, it seems, are necessary in the grand scheme of the Andean universe. Without one, there could be no other.
When someone asks me for my favorite destinations around the world, Peru will always be at the top of the list. If they want details and recommendations, my stock answer is “Don’t skip Titicaca!” Machu Picchu is a given—as it should be—but to travel so far and not have the magical experience of standing at the edge of the lake on a crystal clear morning, would be to truly miss out. And if they ask, “Either/or?” I can only honestly reply, “Both.”
To experience Lake Titicaca in the most immersive way, consider staying at Titilaka, a luxury lodge on a private peninsula that provides guests with daily excursions to the local communities. www.titilaka.pe