Altitude Sickness Update:
Jacob Schor ND
April 12, 3009


We receive many emails and phone calls from people all over the world as a result of past newsletters posted on our website. I don’t know why but a single newsletter from 2004 on altitude sickness generates more interest than all the rest of them combined. The original article can be found at:
http://denvernaturopathic.com/news/altitude.html


Last week I was contacted by a magazine writer asking questions about this subject and this prompted me to review recent publications on the topic. I discovered that since my last article on natural ways to treat altitude sickness, the published medical literature has remained confusing. In the past several studies suggested Ginkgo extracts might be useful. A recent review of these studies suggests the problem with the contradictory results reported might be due to variability in the products used in the different studies. [1]



Mixtures of various antioxidants (vitamin C, E and lipoic acid) even though they demonstrated benefit in past work, showed little benefit in a more recent (March 2009) and larger study. [2] [3]



A number of studies now suggest low doses of theophylline may help. [4] There has been continual interest in using Viagra to prevent symptoms.[5] [6] [7] Theophylline and Viagra together may be helpful. [8] Such Viagra research thus might lend itself to some entertaining double entendres in advertising copy featuring mountain climbers talking about getting to the top of tall peaks. Viagra works by increasing nitric oxide (NO) in the blood stream



The amino acid l-arginine a precursor to NO is often used to duplicate Viagra effect naturally, yet results using it for altitude sickness have been disappointing. Some studies have shown mild benefit, but others have not and one reports that supplementation with l-arginine causes headache.[9, 10]



High altitude causes memory problems. It is thought this is due to brain neurons self destructing. A few things appear protective against this memory loss and brain damage including acetyl-l-carnitine (ALC)and n-acetyl-cysteine. [11,12] The doses of ALC used in the research were exceedingly high and they may not extrapolate to human use.


There are a few papers using rhodiola and a newer one using milk thistle.
A combination of ginkgo, milk thistle and rhodiola might be reasonable to consider.


Though I’m not seeing research yet, I would also consider some combination of L-arginine and pycnogenol, grape seed extracts, curcumin and pomegranate. The later extracts all appear to protect the brain neurons from damage especially due to lack of oxygen.



That’s just a hunch though.



Tried and true homeopathic remedies: homeopathic coca (not sold in the US) and carbo vegetabalis don’t have scientific papers supporting their use but have been used clinically for several centuries. The later homeopathic remedy is easily obtained in health food stores.



References:

1. High Alt Med Biol. 2009 Spring;10(1):33-43.
Ginkgo biloba for prevention of acute mountain sickness: does it work?
van Patot MC, Keyes LE, Leadbetter G 3rd, Hackett PH.
2. High Alt Med Biol. 2001 Spring;2(1):21-9.
Acute mountain sickness; prophylactic benefits of antioxidant vitamin supplementation at high altitude. Bailey DM, Davies B.
3. QJM. 2009 Mar 9.
Oral antioxidant supplementation does not prevent acute mountain sickness: double blind, randomized placebo-controlled trial. Baillie JK, Thompson AA, Irving JB, Bates MG, Sutherland AI, Macnee W, Maxwell SR, Webb DJ.
4. J Travel Med. 2008 Sep-Oct;15(5):307-14.
Low-dose theophylline reduces symptoms of acute mountain sickness.
Küpper TE, Strohl KP, Hoefer M, Gieseler U, Netzer CM, Netzer NC.
5. Expert Opin Pharmacother. 2005 May;6(5):835-7.
Sildenafil for the treatment of altitude-induced hypoxaemia.
Perimenis P.
6. Am J Respir Crit Care Med. 2005 Feb 1;171(3):275-81. Epub 2004 Oct 29.
Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension.
Richalet JP, Gratadour P, Robach P, Pham I, Déchaux M, Joncquiert-Latarjet A, Mollard P, Brugniaux J, Cornolo J.
7. Thorax. 2005 Aug;60(8):683-7
Phosphodiesterase type 5 and high altitude pulmonary hypertension.
Aldashev AA, Kojonazarov BK, Amatov TA, Sooronbaev TM, Mirrakhimov MM, Morrell NW, Wharton J, Wilkins MR.
8. Med Hypotheses. 2002 Aug;59(2):223-5.
Are sildenafil and theophylline effective in the prevention of high-altitude pulmonary edema? Kleinsasser A, Loeckinger A.
9. Eur Respir J. 2001 Aug;18(2):286-92.
Response of nitric oxide pathway to L-arginine infusion at the altitude of 4,350 m.
Schneider JC, Blazy I, Déchaux M, Rabier D, Mason NP, Richalet JP.
10. High Alt Med Biol. 2005 Winter;6(4):289-300.
L-arginine supplementation enhances exhaled NO, breath condensate VEGF, and headache at 4,342 m.
Mansoor JK, Morrissey BM, Walby WF, Yoneda KY, Juarez M, Kajekar R, Severinghaus JW, Eldridge MW, Schelegle ES.
11. Eur J Pharmacol. 2007 Sep 10;570(1-3):97-107. Epub 2007 Jun 13.
Acetyl-L-carnitine ameliorates hypobaric hypoxic impairment and spatial memory deficits in rats. Barhwal K, Singh SB, Hota SK, Jayalakshmi K, Ilavazhagan G.
12. Physiol Behav. 2007 Nov 23;92(4):643-50. Epub 2007 May 24.
N-acetyl cysteine supplementation prevents impairment of spatial working memory functions in rats following exposure to hypobaric hypoxia.
Jayalakshmi K, Singh SB, Kalpana B, Sairam M, Muthuraju S, Ilavazhagan G.
13. Zhongguo Zhong Yao Za Zhi. 1990 Mar;15(3):177-81, 192.
[Electron microscopic observation of the effects of Rhodiola kirilowii (Regel.) Maxim. in preventing damage of the rat viscera by a hypoxic high altitude environment]
[Article in Chinese] Zhang Z, et al.
14. Zhongguo Zhong Yao Za Zhi. 1989 Nov;14(11):687-90, 704.
[Effect of Rhodiola kirilowii (Regel.) Maxim on preventing high altitude reactions. A comparison of cardiopulmonary function in villagers at various altitudes]
[Article in Chinese]
15. Cesk Fysiol. 1998 Jun;47(2):51-2.
Protective effect of flavonoids and tocopherol in high altitude hypoxia in the rat: comparison with ascorbic acid.
Schreiber M, Trojan S.


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