77. Avoiding Altitude Sickness: Tips for Cusco, La Paz, and Denver

Traveling to high-altitude destinations offers some of the most spectacular views and cultural experiences in the world. However, the reduced oxygen levels in cities like Cusco, La Paz, and Denver can turn a dream vacation into a headache-filled struggle if you are not prepared. This guide provides concrete, medical-based strategies and local tips to keep you healthy while you explore the clouds.

Understanding the Elevation Differences

Not all high-altitude destinations carry the same risks. The severity of your symptoms often depends on exactly how high you are and how fast you got there. It is helpful to look at the specific numbers for these three popular hubs.

  • Denver, USA: Known as the “Mile High City,” it sits at 5,280 feet (1,609 meters). Most travelers feel little to no effect here, aside from perhaps getting winded faster during exercise or feeling dehydrated.
  • Cusco, Peru: This is a significant jump. The city sits at 11,152 feet (3,399 meters). At this height, the effective oxygen level is roughly 40% lower than at sea level. Acute Mountain Sickness (AMS) is very common here.
  • La Paz, Bolivia: This requires the most caution. The city center is around 11,975 feet (3,640 meters), but the international airport, El Alto, is located on the plateau above the city at 13,325 feet (4,061 meters). Flying directly into El Alto is one of the most physically taxing arrivals in commercial aviation.

Pre-Trip Medical Preparation

The most effective way to handle altitude is to prepare your body before you even board the plane. While physical fitness does not prevent altitude sickness (marathon runners get it just as often as non-athletes), chemistry can help.

Prescription Medication

Consult your doctor about Acetazolamide, commonly sold under the brand name Diamox.

  • How it works: It acidifies the blood slightly, which stimulates your respiratory system to breathe faster and deeper, especially while sleeping.
  • Typical Dosage: A common prescription is 125 mg taken twice a day, starting 24 hours before you arrive at altitude and continuing for the first two days of the trip.
  • Side Effects: You may experience tingling in your fingers and toes or a change in the taste of carbonated beverages.

Natural Supplements

If you prefer to avoid prescription medications, some travelers use Chlorophyll drops or Ginkgo Biloba. While scientific evidence is mixed, many hikers in the Rockies swear by starting a Ginkgo regimen five days prior to ascent to improve blood circulation.

Strategic Acclimatization: Sleep Low

The “climb high, sleep low” rule is the golden standard of mountaineering. You can apply a variation of this to your travel itinerary to minimize symptoms.

The Cusco Strategy

One of the biggest mistakes travelers make is flying from Lima (sea level) directly to Cusco and staying there.

  • Better Plan: Upon landing in Cusco, take a taxi or shuttle immediately to the Sacred Valley. Towns like Urubamba (9,420 feet) or Ollantaytambo (9,160 feet) are significantly lower than Cusco.
  • Spend your first two nights in the valley. This 2,000-foot difference dramatically reduces stress on your heart and lungs. Visit Machu Picchu from there, then return to Cusco for city touring at the end of your trip when you are acclimated.

The La Paz Strategy

Because the airport is the highest point, your arrival will be the hardest part.

  • Better Plan: Arrange a transfer immediately down into the southern zone of the city (Zona Sur), which is lower than the city center (roughly 10,500 feet).
  • Alternatively, many travelers choose to arrive overland from Lake Titicaca or cross the border from Peru. This ensures a gradual ascent over several days rather than a sudden drop from a plane.

Diet and Hydration Tactics

Your metabolism changes at high elevation. Your body burns carbohydrates faster, and you lose water through respiration twice as quickly as you do at sea level.

Aggressive Hydration

You need to drink between 3 to 4 liters of water per day. In Denver, the air is extremely dry. In Cusco and La Paz, the cold air masks how much you are sweating. If your urine is dark, you are already dehydrated and at higher risk for headaches.

The “Carb” Advantage

For the first 48 hours, shift your diet toward complex carbohydrates. Foods like pasta, rice, quinoa, and potatoes require less oxygen for your body to metabolize compared to heavy proteins and fats.

  • Avoid: Heavy steaks or greasy burgers on your first night. Digestion slows down at altitude, and a heavy meal can cause nausea.
  • Avoid: Alcohol and caffeine. Both are diuretics that contribute to dehydration. Save the Pisco Sour or craft beer for your third night.

Local Remedies in the Andes

In Peru and Bolivia, locals have managed life at high altitude for centuries using natural remedies. You will find these readily available in hotels and markets.

  • Coca Tea (Mate de Coca): This is made from the leaves of the coca plant. It is a mild stimulant that dilates blood vessels and helps with oxygen absorption. Most hotels in Cusco and La Paz offer it for free in the lobby. Drinking two or three cups upon arrival is standard practice.
    • Note: Coca leaves contain trace amounts of alkaloids found in cocaine. It is legal and safe in the Andes, but it can trigger a positive drug test result back home.
  • Soroche Pills: If you didn’t bring Diamox, Peruvian pharmacies sell over-the-counter pills specifically for “Soroche” (altitude sickness). These usually contain a mix of caffeine, aspirin, and sometimes a small amount of acetazolamide.
  • Oxishot: You will see small, handheld canisters of oxygen sold in shops in Cusco. These provide a quick hit of pure oxygen. While they offer temporary relief for shortness of breath, they do not help your body acclimatize long-term.

When to Seek Medical Help

Most symptoms are mild: headache, fatigue, loss of appetite, and trouble sleeping. However, altitude sickness can escalate into life-threatening conditions like HAPE (High Altitude Pulmonary Edema) or HACE (High Altitude Cerebral Edema).

Descend immediately or seek a hospital if you notice:

  • Confusion or difficulty walking in a straight line (ataxia).
  • A wet, bubbling cough or pink, frothy sputum.
  • Shortness of breath even when resting.

Hospitals in Cusco and La Paz are experts in treating these conditions, often administering oxygen and dexamethasone.

Frequently Asked Questions

Is Denver high enough to cause serious altitude sickness?

For most healthy people, no. At 5,280 feet, you might feel a mild headache or get thirsty easily. Serious medical issues like HAPE are extremely rare at this elevation unless you immediately hike up to 10,000+ feet in Rocky Mountain National Park without resting first.

Can I buy Diamox over the counter in Peru?

Yes. In Peru and Bolivia, you can generally purchase acetazolamide without a prescription at local pharmacies (Farmacias). However, the dosing instructions may be in Spanish, so ensure you understand how to take it (usually 125mg or 250mg).

Does being fit prevent altitude sickness?

No. There is no correlation between aerobic fitness and susceptibility to AMS. A young triathlete is just as likely to get sick as an older, sedentary traveler. The biggest factors are genetics, rate of ascent, and hydration.

Is oxygen available at hotels in Cusco?

Yes. most 3-star hotels and above in Cusco and La Paz keep oxygen tanks at the front desk. If you are feeling unwell, ask the reception staff for oxygen. They will usually let you sit with a mask for 15 to 20 minutes to stabilize your levels.