VI. Precautions for High-Altitude Activities


(1) Maintain a Good Mental State

Maintaining a good mental state, an optimistic mood, and strong self-confidence is very important for reducing the physical and mental discomfort caused by altitude sickness. You should have a calm mindset—neither overly nervous nor overly excited.

If you are too tense, worrying unnecessarily, overthinking, or panicking at the slightest discomfort and giving yourself negative psychological suggestions, it may actually worsen your physical discomfort and prolong recovery time. In fact, many symptoms of altitude sickness are related to psychological factors.

Nor should you be overly excited or impulsive. Friends who are new to high altitudes, especially those who arrive quickly by plane, should avoid getting overly emotional, thrilled, shouting, or jumping around just because they see the plateau or snow-capped mountains. This can lead to hormonal imbalance and increased cardiovascular and pulmonary burden,
thereby exacerbating altitude sickness.


(2) Drink Plenty of Water

The reason for highlighting "drinking water" here is to help everyone understand its importance in high-altitude acclimatization.

Many people don’t pay much attention to drinking water at high altitudes, especially some women who try to control their fluid intake due to the inconvenience of travel. This is very harmful to maintaining health and overcoming altitude sickness.

Let’s talk about why adequate hydration is crucial at high altitudes:

When people reach high altitudes, the spinal cord quickly produces a large number of new red blood cells to enhance the blood's oxygen-carrying capacity. These new red blood cells make the blood more viscous. At the same time, due to the dry and thin air, accelerated breathing causes the body to lose moisture faster than at lower altitudes. This dehydration further increases blood viscosity.
Additionally, in a state of oxygen deficiency, the human respiratory rate increases in both frequency and depth, leading to excessive exhalation of carbon dioxide. This results in an overly alkaline bodily fluid environment, causing a condition known as "alkalosis." Alkalosis can disrupt the body’s ion balance, causing tissues and cells to start retaining fluid, leading to swelling or even edema. It also makes the blood more prone to thickening.

Excessively thick blood leads to slow blood circulation and inefficient oxygen delivery. Organs throughout the body may react to oxygen deprivation with various issues such as headaches, dizziness, and sleepiness due to brain hypoxia; indigestion and loss of appetite due to digestive system hypoxia; sluggish movement and fatigue due to muscle hypoxia; slow microcirculation in extremities (toes, fingers, ears, etc.) making them prone to frostbite; and significantly increased burdens on the heart and lungs, among others. These greatly reduce bodily function, worsen altitude sickness, and make recovery more difficult.
Moreover, reduced water intake and edema mean the intestines don’t get enough water to dilute waste, which can lead to difficulty in excretion and even severe constipation.

Got it? During high-altitude activities, adequate hydration helps maintain bodily balance, ensures smooth blood circulation, improves oxygen supply, reduces cardiovascular and pulmonary burden, enables rapid toxin elimination, thus allowing you to adapt to the high-altitude environment in a short time, relieve the suffering of altitude sickness, and recover good health and stamina. It’s no exaggeration to say that water is the best remedy against altitude sickness.
So, how much water and how should you drink to be considered sufficient and appropriate?
Generally speaking, at high altitudes, you should drink at least 4–5 liters of water per day and pay attention to electrolyte balance. Whether your fluid intake is adequate can be judged by whether your urine output is sufficient and whether your urine is clear or at least light yellow.

Drinking 4–5 liters of water at high altitudes is not actually a burden. This amount of water gives you plenty of options: besides plain water, you can add sugar (glucose, fructose, sucrose, honey, etc.) to replenish energy quickly and improve taste; add a certain amount of Na, K, Ca, Mg ions to help improve ionic balance; add vitamin effervescent tablets to supplement vitamins and reduce “alkalosis”; add American ginseng slices to boost immunity and relieve fatigue; add Banlangen (Isatis root) granules to enhance disease resistance…
Personal recommendation: Fruit Punch feels like the most effective overall; brown sugar is cost-effective and works well. Others can be prepared based on personal preferences and tastes, such as Vitamin C effervescent tablets, American ginseng slices, Rhodiola rosea, Banlangen, etc., for variety.
Your water bottle should be carried with you at all times (you can place it next to your bed when sleeping) and refilled frequently. Drink water in small amounts multiple times, rather than waiting until you’re thirsty.

To avoid affecting sleep, you can gradually reduce water intake starting two hours before bedtime to prevent frequent nighttime trips to the bathroom that could lead to catching a cold.

Generally speaking, at high altitudes, you should drink at least 4–5 liters of water per day and pay attention to maintaining electrolyte balance. Whether you're properly hydrated can be judged by the adequacy of your urine output, and whether your urine is clear or at least light yellow.

Drinking 4–5 liters of water at high altitude isn't actually a burden. This amount gives you plenty of options to vary your intake: besides plain water, you can add sugar (such as glucose, fructose, sucrose, honey, etc.) to quickly replenish energy and enhance the taste; you can also add certain
amounts of Na, K, Ca, and Mg ions to help improve your body’s ionic balance; adding vitamin effervescent tablets can supplement vitamins and reduce symptoms of “alkalosis”; adding slices of American ginseng can boost immunity and relieve fatigue; adding Isatis root granules
can enhance your ability to fight off illness…

Personal recommendation: Fruit Punch, which seems to have the best overall effect; brown sugar, which is cost-effective and efficient.Other items can be prepared based on personal preferences and taste, such as Vc effervescent tablets, American ginseng slices, Rhodiola rosea, Isatis root, etc., to keep things varied.

Your water bottle should be carried with you (you can place it next to your bed while sleeping) and refilled at any time. Drink water frequently and in small amounts each time—don’t wait until you’re thirsty.
To avoid affecting your sleep, start reducing your water intake two hours before bedtime, so you don’t have to get up repeatedly during the night and risk catching a cold.

When you keep this in mind and drink heartily at high altitudes, you’ll be amazed to find that altitude sickness quickly fades away.


(3) Stay Warm and Protect Against the Cold

The weather on the plateau is characterized by low temperatures—generally, for every 1,000-meter increase in altitude, the temperature drops by 5–6°C; there are also large temperature differences between morning and evening, as well as day and night, with some areas seeing a swing of 15–20°C; the weather changes rapidly—sunny skies can quickly give way to fierce winds,
thunderstorms, or hail. Therefore, it’s essential to stay warm and guard against catching a cold on the plateau.

Be sure to bring enough warm clothing and change clothes frequently, adjusting your layers promptly to ensure you’re “warm rather than cool.”

In the plains, the habit is to “put on more clothes when you feel cold,” but on the plateau, you should shift to “take off clothes when you feel hot,” using not feeling hot as your guideline. If you wait until you feel cold before adding layers, the chill has already begun to invade and stimulate your body.


It’s recommended to always carry an extra layer of clothing—take it off when you’re hot and put it on when you’re cold. Before getting out of the vehicle, during breaks on the road, or when the weather changes, the first thing you should do is add more clothing.

Also, try to bathe and wash your hair as little as possible. At high altitudes, the body’s functions become unbalanced and immunity declines, making you highly susceptible to illness. A slight mishap while bathing or washing your hair could lead to a cold, with unpredictable consequences—especially for those who have just arrived and are still in the reaction phase.
This is why many guesthouses in Lhasa post signs in both Chinese and English advising guests not to bathe within the first two days of arriving on the plateau.
The choice between life and cleanliness should be crystal clear. If you’re someone who’s particularly fussy about hygiene or even has obsessive cleanliness habits, it’s better to stay home or visit scenic spots in inland areas instead.


(4) Eat a Balanced Diet

In the low-oxygen environment of the plateau, human metabolism is affected, so the functions of the digestive system—including the stomach, intestines, liver, and gallbladder—are weaker than at lower altitudes, reducing the ability to digest and absorb food.

On the contrary, the body’s energy and vitamin consumption on the plateau are significantly higher than at lower altitudes. According to research, the energy expended by the human body on the plateau over five days is 3–5% higher than on the inland plains, and the longer you stay, the more calories you burn;
vitamin consumption under oxygen-deficient conditions is 2–5 times higher than normal.
Therefore, when planning meals at high altitudes, it’s important to consider the limits of the digestive system while also improving nutritional intake.

In terms of diet, increase the proportion of carbohydrates (which should make up over 60%) and plant-based proteins, as well as intake of various vitamins, to quickly provide energy and boost the body’s adaptability.

Try to eat less greasy food. Excessive fat and animal protein not only burden the digestive system but can also worsen altitude sickness.

On the plateau, it’s best not to eat until you’re overly full—maintaining a “seven-tenths full” state is ideal. If you get hungry in between meals, you can have a snack or something nutritious and easy to digest.

Besides getting nutrients from food, it’s recommended to take additional vitamins daily to meet your body’s needs. You can choose supplements like “Centrum” or “21st Century Vitamin,” or opt for various vitamin effervescent tablets.

If you can get used to the taste of butter tea, drink more of it—it can also help alleviate altitude sickness. “When in Rome, do as the Romans do—and stay healthy” holds some truth.

Alcohol consumption at high altitudes should be strictly limited or avoided altogether. Alcohol not only increases the burden on the heart and liver, but its metabolism also consumes a large amount of the body’s water, which can worsen or prolong altitude sickness.

Although we’re talking about food, “smoking and drinking go hand in hand”—so here’s a side note: if you’re a smoker, it’s advisable to reduce or quit smoking when first arriving on the plateau. The main byproduct of cigarettes is carbon monoxide, which has an affinity for hemoglobin 250–300 times stronger than that of oxygen.
Smoking heavily on the plateau can impair the respiratory system’s oxygen exchange and worsen altitude sickness.


(5) Engage in Moderate Exercise

Many online guides suggest that those who just arrive in Lhasa—especially those who flew there—should sleep all day on the first day to adjust to the altitude. Personally, I think this is inappropriate. While sleeping, the body’s functions weaken, which suppresses the active adaptive capacity of the organism and may actually worsen altitude sickness symptoms.


The best way to adapt when first arriving on the plateau is neither to stay still and sleep the whole time nor to engage in strenuous activity everywhere. Instead, maintain a moderate level of activity and actively adjust yourself. For example, you can take a leisurely walk near your accommodation.

When you first arrive on the plateau, it’s crucial to control the pace, range, frequency, and intensity of exercise—move gently and slowly, and be especially cautious the higher the altitude. This is why mountaineers often appear to move in slow motion.

On the plateau, try to learn and use diaphragmatic breathing—it’s much more effective than our usual chest breathing.

Going against these principles often leads to trouble. There have been real-life cases of hikers fainting in the toilet from straining too hard while "squatting" at high altitudes; I myself once made a bet to do a "carp leap" at an altitude of 4,600 meters, which resulted in several days of eye pain.
That’s a lesson learned.


(6) Stay up late, ensure ventilation

Nights at high altitudes are often harder than the days, and sleeping becomes quite uncomfortable.

Environmentally speaking, nighttime air pressure is lower, and with weakened plant photosynthesis, the oxygen content in the air decreases even further. Physiologically, during the day when you're awake, you can consciously adjust your breathing to alleviate hypoxia. But once you fall asleep at night, due to the effect of the parasympathetic nervous system, your breathing gradually slows to nearly the same rate as at sea level, leading to oxygen deprivation and affecting sleep quality.
Friends who have been to high altitudes often have this experience: waking up suffocating, gasping for a few breaths, then going back to sleep; waking again, gasping again, sleeping again... and so on.

However, maintaining good physical condition at high altitudes requires a certain amount of sleep in both quantity and quality—so what can be done?
Four words: stay up late, ensure ventilation.
When first arriving at high altitudes, many people feel drowsy due to hypoxia and go to bed very early. Little do they know that doing so often leads to waking up in the middle of the night and being unable to fall back asleep, staring at the ceiling until dawn. This results in insufficient sleep and can even disrupt the biological clock, affecting subsequent performance. A better approach is to go to bed about one hour later than your usual habit.

On the premise of keeping warm, it’s essential to ensure good ventilation in the room or tent. You can open the window slightly if in a room, or make sure the tent’s vent is fully open, and leave a slight gap in the zipper if needed. The air at high altitudes is already thin—if you’re in an enclosed environment recycling a fixed volume of air, it more easily leads to headaches and other discomforts.
(7) UV Protection

The ultraviolet intensity at high altitudes is very strong and can easily damage the skin and eyes, especially on snow-covered areas. Protective measures must be taken to avoid harm.
In strong sunlight, try to minimize exposed skin. A sun hat (a jungle hat with a wide brim works well), and sunglasses are essential.


Exposed skin should be covered with sunscreen, including the face, ears, back of the neck, hands, and arms. It's better to use sunscreen with a higher SPF (SPF30, PA+++ is ideal; it’s recommended not to go below SPF20 and PA++), which reduces the need for frequent reapplication.

When trekking in cold high-altitude areas, reapplying sunscreen isn’t very convenient and is often forgotten. If you need to reapply, store the sunscreen close to your body to keep it warm—it’ll be easier to apply, and you definitely don’t want to discover it’s turned into an ice stick when you need it.

Also worth noting: even on cloudy days, UV protection measures are necessary. UV rays on cloudy days can still burn your skin, and there have been multiple such lessons.

(8) Necessary Medications and Treatment Measures
In addition to regularly taking health supplements like inosine and vitamins, as well as medications for treating illnesses, it’s generally not recommended to use medications indiscriminately at high altitudes—after all, “all medicine has side effects.” Improper medication use can mask or affect normal bodily responses and recovery.
At high altitudes, it’s absolutely critical to strictly avoid catching a cold. Even a mild respiratory infection increases the risk of high-altitude pulmonary edema. If you notice the initial symptoms of a cold, take cold medicine immediately. Waiting until the symptoms worsen usually renders the medication ineffective.

For some more severe symptoms of altitude sickness, if the severity is confirmed to be mild and unlikely to worsen, necessary medications and adjustments can be made to avoid impacting activities and sleep.


For example, for mild headaches caused by altitude sickness, you might choose Singapore’s “headache pills,” which are traditional Chinese medicine. For more severe headaches, “Excedrin” is recommended and works quite well—in fact, just having this one type of headache medication is probably enough.

When the reaction is more serious, it’s still advisable to see a doctor. After all, doctors in high-altitude areas are very experienced in treating altitude sickness, and seemingly minor or inexpensive medications can produce immediate effects. If the doctor assesses that the issue isn’t serious, wouldn’t that give you greater peace of mind?
Also, for those with slightly more severe reactions, if there’s no danger and you can tolerate it, try not to use oxygen if possible and rely on your own adaptation. Once you start using oxygen, the dependency can be quite strong—you might find it hard to do without it at high altitudes in the future. If you continue on afterward...

At high altitudes, it is crucial to strictly guard against catching a cold. Even a mild respiratory infection can increase the risk of developing high-altitude pulmonary edema. If you notice the initial symptoms of a cold, you should take anti-cold medication immediately.
Waiting until the symptoms worsen before taking medicine is generally ineffective.

For some more severe symptoms of altitude sickness, if the condition is confirmed to be not serious and unlikely to worsen, necessary medication and adjustments can be made to avoid affecting activities and sleep.

For example, mild headaches caused by altitude sickness can be treated with Singapore’s “Headache Tablets,” which are traditional Chinese medicine. For more severe headaches, “Excedrin” is recommended and works quite well—in fact, just having this one headache medication on hand is usually sufficient.

When the reaction is more serious, it is still advisable to see a doctor. After all, doctors in high-altitude areas are highly experienced in treating altitude sickness, and often a few seemingly insignificant and inexpensive medications can produce immediate results. Wouldn’t it feel more reassuring if the doctor determines that there’s no major issue?
Also, for those experiencing slightly more severe reactions, if there is no danger and you can tolerate it, try not to use oxygen and instead rely on your body’s own adaptation. Once you start using oxygen, the dependency can be quite strong—you might find it very hard to do without it at high altitudes in the future.

If you continue on to higher altitudes afterward...
High-altitude travel can be quite stressful and troublesome.
Of course, if the symptoms are indeed severe, or if you plan to descend immediately and have no intention of returning to high altitudes in the future, that’s a different matter.


(9) Maintain Clear Communication

When you notice any unusual changes in your physical condition, you should inform the team leader or someone with experience, listen to their advice, and make further adjustments and adaptations; if you’re traveling alone and feel the situation is serious, seek medical attention promptly. Never push yourself too hard.
Don’t tough it out or hide your symptoms.

Team members should pay close attention to one another. If you notice someone exhibiting particularly unusual symptoms (such as confusion), inform the team leader or teammates immediately and take appropriate action.