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.

The Everyday Actions of Earth Day Heroes Across Latin America

The Everyday Actions of Earth Day Heroes Across Latin America

Every year, Earth Day serves as a fantastic annual reminder to recycle more, plant a tree and turn off the water when brushing one’s teeth. But what about the other 364 days of the year? When the crazy news cycle immediately pulls our attention in 10 million other directions, who is still prioritizing our planet’s wellbeing and keeping conservation & sustainability top of mind as daily guiding principles for operation?    

In many ways, the travel industry has taken up this mantle, being uniquely poised to expose people with the means to travel to our seemingly dim global reality of pollution, habitat destruction and climate change. But it also shines a strong light on practices that prioritize environmental conservation, sustainable operations and projects that preserve local culture while also providing employment in impoverished areas.  

We are lucky to partner with some of the boldest thought leaders and action takers in Latin America when it comes to protecting & bettering the planet. Changing people’s mindsets, taking real action against plastic and waste managements, creating protected wildlife corridors and creating jobs while preserving unique local culture. Here’s a roundup of some of the most impactful sustainability initiatives that your guests can experience at our hotels & lodges in Latin America:

1.)   Promoting Appropriate Luxury at Galapagos Safari Camp

 When Galapagos Safari Camp founders Stephanie Bonham-Carter and Michael Mesdag first climbed a tree and took in the mesmerizing view of the Santa Cruz highlands, they knew they wanted to create a low-impact hospitality experience connects guests with the fragile nature of the Galapagos Islands rather than another predictable hotel.  Their philosophy of “Appropriate Luxury” applies to every decision they make in operating the Galapagos Safari Camp, from relying on rainwater collection to growing their own food and utilizing solar power whenever possible. Questions like “Why don’t the safari tents have AC?” or “Why doesn’t your lodge have Jacuzzi tubs or televisions?” are an opportunity to engage potential guests in a dialogue about the environmental costs of importing the resources (diesel generators and fresh water) to provide these “expected luxuries.” And begs the question that, as visitors to this natural sanctuary, why do we feel entitled to certain amenities that the resident population has learned to adapt without?

 “Consider for a moment that the animals on land have adapted to the lack of freshwater. Giant tortoises can go for months without a reliable source of water, sea lions depend on the fish they eat for their daily intake and Darwin’s finches wait until the wet season to mate.”

GSC invites guests to adjust their own vision and expectations of what “should” be available and considered luxury, setting aside notions of ordinary opulence in exchange for truly engaging with a different and unique environment.  Visit their website for a deeper dive into the concept of Appropriate Luxury.

2.)   Waging War Against Waste at Machu Picchu: Inkaterra Machu Picchu Pueblo Hotel

 What happens when an isolated archeological wonder without overland highway access attracts nearly 1.6 million visitors a year? A massive amount of waste is created and left behind, so much so that in 2016 the waste management crisis at Machu Picchu contributed to the Inca citadel being evaluated for UNESCO’s list of ‘World Heritage in Danger.’

To manage the impact of trash left behind by visitors, Inkaterra & beverage manufacturer AJE group have partnered to launch an organic waste treatment plant in Machu Picchu Pueblo.  This will make the area the first in Latin America to manage 100 percent of its solid waste through pyrolysis, which decomposes the waste at high temperatures without oxygen. The plant has the capacity to process seven tons of waste per day to generate bio-coal, a natural fertilizer that will help with the reforestation of the Andean cloud forest and contribute to agricultural productivity in Machu Picchu.

This is in addition to other initiatives that the Inkaterra Association has already spearheaded in the region.  To address the plastic waste left by tourists, they already operate a compacting and recycling center that  processes a staggering average of 14 tons of plastic daily.  And to discourage local communities, hotels and restaurants from disposing their used cooking oil into the Vilcanota River, Inkaterra helped build a biodiesel production plant to process used oil. The plant produces 20 gallons of biodiesel daily from nearly 6,000 liters of used oil a month.

Inkaterra — with properties in the heart of the Machu Picchu cloud forest, deep in the Amazon rainforest, in the city of Cusco and in the Sacred Valley of the Incas — creates authentic travel experiences, while preserving biodiversity and local cultures in Peru.

 
3.)   Protecting Pumas Beyond the National Park: Awasi Patagonia

Chile’s Torres del Paine National Park is considered the best place on the planet on see the elusive puma thanks to an abundance of juicy guanacos to feed on and protection from hunters within park boundaries since 1972. An estimated 50 cats currently live within the park and studies indicate that their numbers are on the rise.

But what happens to the big cats when they roam beyond the borders or TDP where they are not protected?  Close to 100 pumas are killed each year in Chilean Patagonia, mostly by sheep ranchers offering a bounty payout on puma skins.  And as the puma population grows, along with the annual number of visitors to Torres del Paine, these solitude-seeking predators are more likely to wander beyond their invisible safety net.

To counteract this issue, Awasi Patagonia and the Awasi Puma Foundation have created a 11,000 acre protected corridor adjacent to the park, turning a former sheep farming estancia into a private reserve. Native grasslands and shrubs have been allowed to regrow after years of overgrazing and the private status of the reserve keeps human visitors to a minimum, allowing free and safe reign to its rightful inhabitants: guanacos, pumas, condors and other species.  

While the Awasi Puma Foundation is relatively new, its impact is already measurable. Earlier this month, a guide at Awasi Patagonia spotted two rare Geoffroy’s Cats kittens on the private reserve, indicating that this seldom seen feline is thriving in the protected corridor adjacent to the park.  Guests of Awasi can join a biologist researcher and guide on a special puma tracking excursion in the private reserve.

4.)   Preserving Cultural Heritage: El Otro Lado & Bahia Portobelo Foundation

 Portobelo was once the busiest city in the New World and the point for all trade between Europe and of South America, including the inhuman trade of enslaved Africans.  A small group of slaves – the Cimarrones - won their freedom and established their own communities in and around Portobelo where they preserved and celebrated their African heritage.

With the creation of the Panama Railroad and Panama Canal, Portobelo’s usefulness as a trade port was eliminated. While economic opportunities flourished in Panama City and along the Canal Zone, the gap between the country’s rich and poor widened, aided by racism and little government support for infrastructure and education in remote areas. Along the Caribbean Coast, areas with indigenous or minority populations such as Portobelo were cut off from the prosperity of the other side of the country.  Panama today is one of great contrasts and an income inequality comparable to Brazil and South Africa.

Founded in 1993 as the Portobelo Workshop, today’s Fundación Bahía de Portobleo, supported in part by El Otro Lado, works to improve the local quality of life by promoting socioeconomic projects within the community that also preserve & celebrate the community’s African identity.  Guests at El Otro Lado are invited to discover the soul of Portobelo’s Congo Culture through drumming lessons or cultural dance performances with local students at the Escuelita del Ritmo (Little School of Rhythm) or art and woodcarving workshops at the art studio. Today, the foundation supports over 100 local students with free classes in music, dance, art and educational support.  The facilities house five music rooms, a dance room, workshops, study halls, English and computer labs, a recording studio and a multi-use room for recitals, concerts and cinema. Much of the support comes through tourism, and the two hotels and restaurants fully run by the foundation, as well as El Otro Lado, account for the employment of over 100 local people.

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.