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An Attitude to Altitude
A man without money is a fool.
Pashtun proverb
Shamans get high. Go higher. By travelling to altitude and breathing in a certain way, it is possible to achieve mental states – useful or not – that resemble those achieved through more conventional forms of intoxication. Everything about the Himalayas is about going higher, sometimes in all senses of the phrase. The myth of Milarepa is so central because on one level it is also a battle about who is best at altitude.
Being good at altitude is like being good at maths or languages; it seems you either are or you aren’t. But that doesn’t stop some surprising hard workers who overcome an initial disability. Generally, the top climbers find a challenge in the hypoxic state that normal people find repugnant or sickening. The desire to push on when your mind is slowing down and your body refusing to do even basic tasks with ease requires a special kind of person. It could simply be a kind of schadenfreude – you find that, although you’re feeling poorly, you can disguise the effects better than the group you are climbing with; the sicker they get, the better you feel. This kind of climber always suffers when they cannot lead or strike out on their own. Following is a physical insult to their whole mind-body continuum. Reinhold Messner definitely falls into this category; indeed, he views this need to go at his own speed as a matter of safety – a conventional alibi for someone who needs to control every element of their progress upwards. Another realisation, perhaps unarticulated, is that rhythm, the syncopation of breathing and limb movement, has a disproportional effect on success at altitude. I suspect, though, that such people when they climb derive their will to climb by beating others. Solo climbing suits them because in one sense they are beating everyone. When they climb in a group, they simply have to be better than everyone in that group; the more their companions fail, the better they feel. One might reasonably speculate that the death of any member of the party is actually a disguised form of triumph for such a climber, leading to complicated feelings and possibly a disgust with the whole enterprise of high-altitude gambolling/gambling.
What becomes apparent as you gasp your way higher than 3,000 metres is that you need an attitude to altitude, otherwise you will turn back too soon or carry on when you shouldn’t. Altitude effects are among the most profoundly unnatural sensations that one can experience in nature; no wonder our ancestors thought they were caused by miasmas and exhalations of poisoned ground. Altitude sickness is not only counter-intuitive (shouldn’t the air be cleaner and clearer higher up?), it is also counter to the way our bodies work. Those peoples and tribes who have learned to live at altitude have evolved bodies that function differently to a lowlander’s.
A further mystery of altitude sickness is that it is democratic, striking the young as readily as the old. The super-fit can be laid low at 8,000 feet while an inveterate smoker has no problems at all. Women can go just as high as men. In 1978, Roman Giutach-villi, a forty-year-old Russian with one lung, reached the summit of Everest. Immunity, like God’s grace, is dispensed in a way that seems arbitrary.
My own experiences are as good a starting point as any in this highly complex area. Being basically unfit, I had only a limited interest in the athletic aspect of climbing high; and the bagging of peaks, though obviously addictive, seemed a bit mechanical (a bit easy, while at the same time monstrously difficult). Still, I was intrigued at how my body would react to going higher. It became an idée fixe, my own demon. Though my researches showed altitude adaptation was not a benchmark of health or fitness or youth, I’d always taken it to be strongly connected to these things. I noticed that many trekkers I came across in the Himalayas were really quite elderly; on one trek, I was the youngest – and I was fifty. The oldest man was sixty-five, very spry, fitter than me and certainly ‘better’ at altitude. And why not? The oldest person to climb Everest is Yuichiro Miura, an eighty-year-old Japanese man. In my mind lurked an idea, a strange transmutation of the mystical religious notion of going higher as a defence against mortality. By literally going higher, I would either accrue some kind of benefit or receive a sign that indicated I was on for a ripe old age, and could look forward to the kind of balmy later years enjoyed by such folk as Yuichiro Miura – and when you’re fifty, eighty seems immortal, especially when it involves climbing 8,000-metre mountains. If you could keep going a bit longer – through such healthful activities as going high in the mountains – then maybe you would live for ever; or at least you could put off thinking about it. . .
Going higher is possible even with one lung
But I found I couldn’t. My first excursion above 4,000 metres told me I was certainly no natural at altitude. Intent on keeping up with the guide, I found myself feeling light-headed, queasy and lacking in any kind of stamina. We were below a pass reached by climbing up a grassy slope. I made the mistake of cutting directly upwards from one switchback to another; the sudden increase in exertion forced me to halt for several minutes of recovery. Used to being something of a mountain sprinter, the humiliation of being unable to move fast added to the discomfort of altitude sickness.
Altitude sickness is a fascinating disease – because it isn’t really a disease, it is more a physical record of the body’s adaptation, or lack of it, to the new conditions found at altitude. The most important of these is lack of oxygen, but, as we’ll later find out, other ascenders to the heights of the Himalayas have found that dehydration, gastric illness, lack of the right food and sun blindness can create or exacerbate symptoms of altitude sickness.
The central problem the body has to solve is how to re-establish the same levels of oxygen in each cell as would be experienced at sea level. But this doesn’t just mean breathing more heavily.
The brain is calibrated for sea level, and at sea level the less carbon dioxide there is in the blood, the more oxygen there must be. But at altitude it’s all different. You over-breathe to get more CO2, but this strips out the CCU So the brain ‘thinks’ you actually have too much oxygen. It constricts blood vessels to reduce blood flow and minimise this imaginary excess of oxygen. Breathing deeply to get more oxygen into the system results in losing more carbon dioxide, so the brain vasoconstricts even more – causing a headache, probably. Breathing is then reduced to match the vasoconstriction (which is why the headache goes), but this means less oxygen – the opposite of what you need. Eventually, some kind of balance is reached – through reducing activity to a minimum. Carbon dioxide diffuses much more readily in the blood than oxygen, so the rates of readjustment are different and complex – causing the wide variety of symptoms associated with altitude sickness.
One way to visualise the push-me pull-you effects of altitude on breathing is to look at sleep apnoea – very heavy snoring. At lower altitudes this condition is common among the elderly and those with lung problems, but above 2,500 metres it occurs in people with normal lung function. It’s a kind of schizophrenic fluctuation mediated by a lack of CO at one end and a lack of O2 at the other. A period of rapid and increasingly deep breaths prompted by a lack of oxygen are followed by shallower breaths (because carbon dioxide levels are low) until, alarmingly, breathing almost stops. At this point oxygen levels become critical, leading to a big intake of air – and then the cycle repeats. When someone is snoring like this, it can be rather frightening to observe.
The reason for the clumsy and slow adaptation to altitude is to alert us to the new and potentially dangerous situation we find ourselves in. Pain is a message to get lower, return to the status quo. If we reacted to a lack of oxygen by simply breathing more deeply, we could effortlessly keep going higher and higher with little adverse reaction. But going higher has many corollary problems – it is colder, more dangerous, lack of oxygen dulls the brain and causes us to make stupid decisions. The higher you go, the less food there is and water tends to be frozen. The optimum settlement zones are near sources of food, like the sea; we have evolved to work best at sea level. The body wants us
to stay in the safety zone.
The earliest written accounts of altitude sickness date from AD 20. Written for the benefit of Han Emperor Wu Di, the description of crossing the Karakoram speaks of climbing Mount Greater Headache and traversing Mount Lesser Headache. Around AD 400 the Chinese pilgrim Hiouen Tsang would write that the cause of altitude sickness was the mists exhaled by the mountains and mountain vegetation: ‘Rhubarb is abundant there; it exhales a very strong odour which annoys the traveller very much.’
Other early theories were nearer the truth. Francis Bacon, quoting Livy and a lost manuscript by Aristotle, wrote: ‘The ancients had already noted that on the summit of Mount Olympus the air was so rare that in order to climb it one must take with him sponges wet with vinegar and water and place them on the nostrils . . . the air, because of its rarity, did not suffice for respiration.’ Indeed, in Europe before the eighteenth century, it was widely believed that the summits of Alpine peaks were too high for humans to survive. This despite first-hand evidence that high altitude was not necessarily fatal. In 1590, the Jesuit priest José de Acosta managed to climb to 5,716 metres in Peru. He wrote, ‘I was surprised with such pangs of straining . . . meat, phlegm and choler (bile) both yellow and green, in the end I cast up blood with the straining of my stomach . . . If this had continued I should undoubtedly have died.’
We want to get higher, and yet something wards us off. Monasteries have often been sited at considerable height, though rarely on top of peaks. The Great Saint Bernard Monastery is the highest in Europe at 2,469 metres, above the timberline, roughly at the height that the first mild symptoms of altitude can be felt. There is 25 per cent less oxygen here. A fifth of people who get rescued by a Saint Bernard dog will be suffering from headaches, nausea and general lassitude. But for those that can adapt, a reduced oxygen intake can be mildly euphoric. This is not to say that a sharpened spiritual sense amounts to nothing but a shortage of air. It might be that, as with fasting, a reduced intake of some vital substance encourages us to re-evaluate life.
Breathing impacts on our mental state in so many ways. It is the basic method of yoga and other systems that seek an integration of mind and body. We will see later how the Tibetan system of Gumno is used to raise body temperature to a significant degree – and the two key elements in Gumno are breathing and visualisation.
Breathing affects oxygenation levels. Over time, we become used to a certain replenishment rate, a certain level of oxygen in each cell. If you inhale some pure oxygen from a tank it will make you mildly euphoric; it can also cure a hangover. It takes three molecules of oxygen to metabolise one molecule of alcohol. Your body becomes mildly hypoxic as it uses oxygen to convert the alcohol to usable products. This is why running for a bus after you have had a lot to drink is always much harder than a usual sprint – your body is depleted of oxygen. It’s also why a hangover caused by smoking and drinking is always worse than one caused simply by imbibing too much alcohol. Unsurprisingly, the symptoms of altitude sickness tend to mimic those of a hangover – headache, tiredness, nausea, thick-headedness. All part of the body’s response to lower levels of oxygen in every part of the organism.
So, sensibly avoiding such pain, most humans have left the mountain summits to the gods – on Olympus, Ararat, Sinai, Kai-lash. Indeed, it was only in the enlightened eighteenth century that Europeans began to bridle at the shadow of these giants. In 1760, Horace-Bénédict de Saussure, an aristocrat, philosopher, meteorologist, early geologist and physiologist, offered a cash reward of 20 thalers to anyone who could climb Mont Blanc. It was a sizable sum, equivalent to several months’ earnings for a Chamonix local. What more fitting symbol of the dethronement of the deity? (Perhaps significantly, ‘thaler’, from which we get ‘dollar’, comes from the German , meaning ‘from the valley’.) In 1776, Canon Bourrit of Geneva ascended the nearby Mont Buet on foot. Buet was 3,000 metres high, a huge achievement for the time. Bourrit believed he had reached the highest point one could safely attain: ‘It would be difficult if not impossible to live long on the summit of Mont Blanc.’ He reported having to stop and rest every fifty steps.
In the meantime, other ways to get high had been emerging. In 1709, the first small hot-air balloon was demonstrated in Europe. It rose about 4 metres. In 1766, Henry Cavendish published a book about a gas lighter than air: hydrogen. And then in 1783, the Montgolfier brothers, paper makers who had observed the way a fire’s heat could carry paper skyward, built a two-man hot-air balloon. In the same year the world’s first hydrogen balloon was constructed and powered by pouring a ton of sulphuric acid on to several tons of scrap iron and piping the ensuing gas into a silk envelope. The pilot, Jacques Charles, rose to over 2,900 metres. The following year the chemist Joseph Proust rose to 4,000 metres in a Montgolfier-designed balloon.
No one had claimed de Saussure’s prize yet. Several attempts were made, but all turned back reporting ‘stagnation of the air’ and a great ‘distaste for provisions’. And yet, fear of altitude was lessening, in part thanks to the balloon experiments. In 1786, Chamonix crystal-hunter Jacques Balmat tried to find a way to the summit. He failed and got stuck; forced to bivouac overnight at over 3,500 metres, knowing that ‘the people of Chamonix believed that sleep at these great heights would be fatal’. When Balmat emerged the following day, a bit cold and stiff but otherwise fine, a psychological barrier had been broken.
Later that year, Balmat and a Dr Paccard, using several poles to bridge crevasses and a ladder for a difficult bit, climbed Mont Blanc – 4,800 metres – for the first time. They both suffered from what they believed to be the ‘foul air’ at that height. It would take fifty more years for the true causes of altitude sickness to emerge.
Travelling in Mexico in the mid nineteenth century, a French doctor named Denis Jourdanet noticed the effect of the high mountains on travellers. The locals seemed unaffected. He decided to test their blood, and found that reduced oxygen levels, caused by reduced atmospheric pressure, resulted in an increased red blood cell count.
After only a few days at altitude, the body releases whatever red blood cells it has in reserve and the marrow starts manufacturing more. This tends to have the effect of clogging the capillaries, slowing the circulation of oxygen. In response, blood vessels increase in diameter, some doubling in size. All of which is a stress to the system, though some people react better than others.
Jourdanet was independently wealthy, and he gave his younger friend and colleague Paul Bert financial support for further studies on the physiological effects of altitude. To this end, in 1875 Bert sponsored a balloon ride. The three balloon enthusiasts enlisted for the experiment had access to oxygen, but not enough, as Bert realised just after they took off. It was too late. The sole survivor, Tissandier, wrote:
I now come to the fateful moments when we were overcome by the terrible action of reduced pressure. At 22,900 feet. . . torpor had seized me. Croce is panting. Sivel shuts his eyes. Croce also shuts his eyes . . . At 24,600 feet the condition of torpor that overcomes one is extraordinary. Body and mind become feebler . . . There is no suffering. On the contrary, one feels an inward joy. There is no thought of the dangerous position; one rises and is glad to be rising. . . I wished to call out that we were now at 26,000 feet, but my tongue was paralysed. All at once I shut my eyes and fell down powerless and lost all further memory.
The balloon crashed after reaching nearly the height of Everest. These tragic experiments lead to a greater understanding. Paul Bert’s name lives on in several ways: one is his dicta that those who conserve energy adjust best to altitude. Hard work is penalised: in the 1968 Mexico Olympics, staged at 2,300 metres, rowers performed badly and suffered from altitude sickness owing to the massive demands made on their aerobic capacity. Those events that required only short bursts of activity (you barely need to breathe during the 100 metres) set records in the lower-pressure air.
As every doctor will tell you: the only cure for altitude sickness is to go lower, back to the humd
rum valley. Some people acclimatise, some don’t. There is one drug – Diamox – that does make it easier for most people. It works by altering the acidity of the blood, which, in a complicated way, allows you to breathe more freely and deeply. There is another drug, however, that has been tested recently on Mont Blanc at the Observatoire Vallot situated 305 metres below the summit at 4,350 metres. The Observatoire was built in 1890 – the world’s first high-altitude laboratory. (With French attention to culinary detail, needless to say, it has a superbly equipped kitchen.) Tragedy struck early on, when, in 1891, a Dr Jacottet began to suffer the usual symptoms of altitude sickness: headache, breathlessness when doing exercise. These symptoms continued to worsen until the doctor died. The autopsy revealed the world’s first scientifically recorded case of HAPE (high altitude pulmonary edema). Nowadays we know we must descend the mountain at the first sign of symptoms; once it has set in, and fluid is leaking into the lungs, there is a 44 per cent mortality rate. In the costly business of learning about altitude, Dr Jacottet was another martyr.
Yet people continue to offer themselves up as victims at the Observatoire. The basic measure is the ‘exercise maximum’: you are forced to pedal on an exercise bike until you can pedal no more. In 2005, a group of twelve Frenchmen were tested doing this, but half had received a drug it was hypothesised would combat altitude sickness – Viagra. Viagra dilates blood vessels so that more blood can flow, typically in blood vessels that are constricted for some reason – for example, enabling a flaccid penis to become erect. In the case of those suffering from altitude sickness, constricted blood vessels in the lungs open up to allow more blood, and therefore more oxygen, to reach the brain. In other words, it makes you more like a Tibetan.
White Mountain Page 6