What’s the Deal with Altitude Sickness in Peru, and How to Avoid It?

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.

Summer Trips that Transform - Inkaterra Guides Field Station

Immerse Yourself in Amazon of Southern Peru at Inkaterra Guides Field Station

Many visitors are happily surprised, if not shocked, when they check into one of Inkaterra’s luxury properties in Peru like the Inkaterra Machu Picchu Pueblo Hotel to discover it contains the world’s largest collection of native orchid species (372) in the world and an Andean Spectacle Bear Rescue Project.  Or to learn that they are sleeping in one of Cusco’s most historic and meticulously restored XVIth century mansions, the same very place Simon Bolivar once called home, when arriving to Inkaterra La Casona. 

Most guests learn, only upon arrival, that their Inkaterra luxury hotel (usually chosen due to rave reviews, luxury hotel association affiliations and glossy travel literature or awards) is actually integral to the broader aims of the non-profit Inkaterra Association (ITA).  The Inkaterra Association is self-funded through ecotourism profits and is committed to scientific research as a basis for biodiversity conservation, education and the preservation of Peruvian culture and history.

Guests staying at Inkaterra properties not only support ITA by funding this vital work through their hotel choice, but in turn, their experiences staying at these properties are enhanced by learning about the rich cultural and natural heritage that Peru contains, the threats facing its well-being, and the steps ITA is taking to confront them.  It’s the “ah-ha” moment where luxury travelers turn into eco-tourists and begin to seek out, on future travels, properties and experiences that are not just extremely well appointed, but are also educational, interactive and focused on giving back.

Understanding that today’s travelers, or those turned on to this style of travel from previous stays, are now, at the outset seeking out a more experiential style in their hotel choices, as opposed to solely tangible luxury amenities – Inkaterra has opened the doors of its Inkaterra Guides Field Station, deep in the Southern Peruvian Amazon, to guests.

Less refined in infrastructure and amenities than Inkaterra’s other two, well-heeled, neighboring Amazon Lodges, Hacienda Concepcion and Reserva Amazonica – The Inkaterra Guides Field Station was built and still functions as an educational and scientific field station for visiting scientists, volunteers and students.  And as the name implies, it is where Inkaterra’s own explorer guides are trained in managing ecological projects, gain knowledge of the different Peruvian ecosystems and in guiding skills to be applied in work at any of Inkaterra’s properties throughout Peru.

Although still able to experience the popular tourist excursions provided by the other two Inkaterra Lodges in the area, such as the Inkaterra Canopy Walkway or the numerous trail networks – guests at the Inkaterra Guides Field Station get special behind the scenes access and the opportunity to participate in and learn of the ongoing projects at the field station such as the maintenance and creation of the bio-orchard of native edible plants, the “palmetum” which conserves a diverse sample of native palms, bird monitoring through techniques such as banding for codification of species and the monitoring and identification of fauna through a network of digital trap cameras around the property.

Through recently opening the Inkaterra Guides Field Station to regular eco-concious guests in search of a hands-on experience, Inkaterra has come full circle in their mantra of spreading “conservation through tourism”.  The educational aspect of staying at their other more well-known luxury properties around Peru is not just an enhancement here, it is a fully integrated experience for those seeking out a transformational travel experience.
 

How to Book
Stays at the Inkaterra Guides Field Station can be booked via any travel agent, tour operator or directly via Inkaterra by emailing sales@inkaterra.com

Accommodation is provided in either 2 or 4 person cabanas or in one of two shared dormitory style pavilions.  All meals and choice of guided excursions with a bilingual explorer guide, as well as motorized dugout canoe transfers to and from Puerto Maldonado airport (PEM) are included in the rates.  (Other optional excursions are available at additional cost) Puerto Maldonado is serviced by numerous daily direct flights from both Lima and Cusco. 

Location
The Tambopata National Reserve is one of the last easily accessible virgin tropical rainforests in the world. The Reserve, a 768,774 acre area, offers a wealth of biodiversity, as well as magnificent natural landscapes. Puerto Maldonado, known as the “Capital of Biodiversity,” is the largest city of the Tambopata region. Overlooking the confluence of the Tambopata and Madre de Dios Rivers, Puerto Maldonado is 1,312 feet above sea level, 404 miles from Cusco, and 9 miles upriver from the Inkaterra lodges.

Luisella Garmendia of Inkaterra La Casona - The People Behind the Experience

Luisella Garmendia of Inkaterra La Casona

 - The People Behind the Experience -

For travel professionals that organize and sell high end travel to Peru, most have a love/hate relationship with Inkaterra La Casona.  They love when they are able to get availability in one of the 11 exclusive suites for their clients, it allows them to offer something so authentic and exclusive that sets their services apart from the masses.  But due to the small size and sterling reputation of the property amongst industry insiders, they hate that availability, more often than not, results in the dreaded waitlist game. 

We sat down with Luisella Garmendia, the General Manager, to learn a bit more about Inkaterra La Casona and what sets it apart in Cusco

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First, what was your background prior to becoming GM of Inkaterra La Casona?

I worked many years for the Belmond chain of hotels, when they were still called Orient Express Hotels. I worked as receptionist and then in guest services at the Monasterio Hotel, which sits just across the Plazoleta Nazarenas from La Casona. Then I spent a few years in sales for the Belmond Miraflores Park Hotel in Lima. In 2008 I was offered a role in guest services for Inkaterra and took it, eventually assuming the role of GM at Inkaterra La Casona in 2010.

...only those with one of the 11 rooms keys get a chance to experience the history behind these doors.

Considering that Belmond is one of the most internationally recognized luxury hotel brands, what was it that made you decide to go work for Inkaterra?

Correct, I'm extremely grateful for my time with Belmond and still have the utmost respect for the brand, their hotels and service standards. With that being said, first, I wanted to get back to Cusco, there is something magical about this city that never leaves you. Second, I had worked in hospitality long enough to know that what I loved doing, and what makes me happy, is interacting with guests. Inkaterra La Casona, having only 11 suites compared to the much larger hotels I had experience working in, was just a perfect fit for me. You can really get to know each and every guest on a personal level, and the setting is more intimate. I never think anymore in terms of check in and check out, but rather of welcoming them into my home for a few days and making sure they leave feeling like they were part of something special for the time they were with us. Third, I'm proudly Peruvian...and had watched this beautiful colonial building sit in a state of sad abandonment for many years before Inkaterra acquired it in 1999. Then over years and years, the most thoughtful and dedicated restoration process unfolded by Inkaterra. Although known for their hotels, Inkaterra is a true champion in sustainable development and in conserving the biodiversity and cultural heritage that Peru offers visitors. So being invited to be part of such a tremendous local vision, the pride that came along with being able to share that with visitors, and the simple fact of working in Cusco's most storied building every day was just something I would never pass up. Inkaterra La Casona is also the only Relais & Chateaux property in Cusco, a real distinction for travelers looking for someplace unique.

One of just two of the Plaza View Suites at Inkaterra La Casona

Speaking about the history of Inkaterra La Casona, in a nutshell, what makes it so unique in Cusco?  

Oh, wow...in a nutshell? Hahaha... This site during Inca times was the Warakos Academy, it was the training center for the most elite of the Incan army. The foundations of the current building here are original Inca walls from that period of time. Then after Francisco Pizzaro's conquest of the Inca Empire during the late 16th century, this was the first colonial building erected on top of Incan ruins after the siege of Cusco. The house was first home to Diego de Almagro, who was one of Pizarro's Captains during the Inca conquest and later become the first European discoverer of Chile. Next, La Casona was home to Captain Francisco Barrientos and Don Juan Alvarez de Maldonado who is credited with expanding the conquest into the Amazon. And then the most notable resident of the home was Simon Bolivar who lived here after leading the independence of Peru from Spain in 1825.

So, what about during your time as General Manager, who are some of the most memorable guests you have cared for?  

Well, Mick Jagger of the Rolling Stones has a special affinity for Peru and La Casona is his home when in Cusco. We have also had Bono from U2 and Antonio Banderas, to name just a few.

But probably my most memorable guests were in 2014 when the Dutch Royal Family - King Willem-Alexander, Queen Maxima, along with their children and grandchildren were our guests, they were such a lovely family to host.

When you are not working, what do you do?

I'm always working. But, I have two precious little girls, so I'm enjoying time with them on days off....while still always attentive to what is happening at the property.