Articles - Gear: Expedition health and nutrition
Julie-Ann Clyma - Posted on 18 Nov 2009
Anyone going to altitudes above 2,500m needs to consider the risk of altitude sickness. There are three common forms, the least serious being acute mountain sickness (AMS) which almost everyone will experience. The symptoms may sound benign - headache, loss of appetite, nausea, disturbed sleep, and peripheral oedema- but if you experience any of these you should take a rest day, and if symptoms don’t disappear, or worsen, then you should descend. In some cases AMS can progress very rapidly to the serious and life threatening conditions of high altitude pulmonary oedema (HAPE) or high altitude cerebral oedema (HACE). To deal with these you need to ensure that your first aid kit contains the essential drugs nifedipine and dexamethasone but again, if at all possible, the victim must descend. All these conditions are linked to rapid ascent and poor acclimatisation, so it is recommended that above 3,000m you should ascend no more than 300m-500m each day, and that for every 1,000m of height gain you should spend a second night to allow your body to acclimatise. Further information on risk factors, symptoms, management and treatment of all these forms of altitude sickness, are provided by the International Society for Mountain Medicine (www.ismmed.org/np_altitude_tutorial.htm) and the UIAA Medical Commission - Emergency field management of AMS, HAPE and HACE (www.theuiaa.org/medical_advice.html).
Frostbite and cold Injury
Frostbite can be avoided even at very high altitude and in the coldest conditions with good equipment and by being constantly attentive whenever you feel your fingers or toes getting stiff and numb. However, in reality, once you get extended on a route with hard climbing and/or bad weather, that attention tends to slip and then cold-affected digits soon turn to cold-damaged ones. Generally frostbite rarely occurs in still air above -10°C but may do so at higher temperatures in windy conditions due to the windchill effect. In early superficial frostbite the skin is mottled-grey and numb and leathery to the touch. In deep frostbite the tissue is hard, white and obviously frozen solid. Having personal experience of the latter I can happily report that with good management the long term damage can be minimal. But the important factor for anyone with frostbite is that once re-warmed the affected area should not be used, otherwise extensive tissue damage will result. More detailed information on cause, symptoms and treatment can be found in the books already mentioned, and on-line at www.emedicinehealth.com/frostbite.
Other health problems
On a more basic level, your expedition can equally be ruined by something as prosaic as a gut infection caused by unsafe water or contaminated food. Good hygiene for the whole expedition, but especially those preparing food, is the main preventative step. Keep latrines well away from the camp area and water supply and keep soap and water readily available at base camp to promote hand washing. I also like to have a small bottle of antiseptic hand wash gel for when there is no water available for hand washing. It is relatively easy to control hygiene measures once you get to base camp and the more risky times for getting ill are perhaps while you’re on the road and staying in villages and towns. It is getting much easier to get bottled water in many destinations and this is a hassle-free way to ensure you keep hydrated. In terms of eating out a general rule is to avoid uncooked food, but even this isn’t failsafe. For advice on best practice in these areas read the following fact sheets - Traveller’s Diarrhoea: Prevention and Treatment in the Mountains and Water Disinfection in the Mountains (www.theuiaa.org/medical_advice.html).
There are also a multitude of other health problems that at home, within easy reach of a doctor, you would hardly be concerned about. But when you are days or weeks away from the nearest medical service you need to be prepared for things as varied as toothache, bladder infection, snow blindness, mouth ulcers, boils, coughs....the list is extensive. Having a fairly comprehensive (but compact) first aid kit is essential and, more importantly, the knowledge of how to manage and treat these problems. Having some members of the expedition recently trained in wilderness first aid would be a sensible measure, and there are courses provided through the national mountain centres like Plas y Brenin (www.pyb.co.uk/courses/first-aid.php), and the Royal Geographical Society has a useful list of providers for basic and advanced courses (www.rgs.org).
First Aid Kit
The actual content of your first aid kit will vary depending on how remote your expedition is, and how much medical expertise (if any) you have on the team. Typical contents for a first aid kit I take are shown below (in addition are a range of bandages and dressings), and there are also useful lists in the books Travel at High Altitude and The High Altitude Medicine Handbook. Many of the medicines you are going to need will require a prescription (e.g. analgesics, antibiotics, altitude medicines) but I have always found that GPs are happy to help provided you can show some form of evidence that the expedition is a proper undertaking. A letter from a sponsor, a grant-giving body like the MEF or BMC, or some form of publicity is usually enough. Some drugs may also need to be declared for export, and advice on this can be found at medex.org.uk/links/travel_medicine.php. It is possible to buy a lot of medicines in destination countries, and it is cheaper to do this, but medical advice is to buy at home where you can be sure you are getting the authentic drugs.
First Aid Kit Contents
mid - aspirin/paracetamol/ibuprofen
moderate - get medical advice
strong - get medical advice
Imodium for diarrhoea
Throat & chest
Cream for ulcers & cold sores
Antibiotics for infection
Tooth-fil temporary filler
Antihistamine for allergies
Antibiotics for infection
Eyes & ears
Analgesic/antibiotic eye drops
In case of serious illness or accidents it is unlikely there will be a local, professional rescue service (unless you happen to be at Everest base camp). So any evacuation you can expect to have to organise yourself. Communication via radio and satellite phones has become cheaper, and also easier in terms of regulations surrounding their use, but check on restrictions and regulations through tourism ministries or mountaineering associations in the part of the world you are intending to travel.
There’s no doubt that being well hydrated and nourished will help your climbing performance. Climbing at altitude is the equivalent of being an endurance athlete and the physical exertion means you are likely to need more than double the normal calorific intake required at sea level (which for women is around 2,000 calories per day and for men about 2,500 calories). It can be difficult to achieve sufficient food intake for a variety of reasons. First, just being at altitude will reduce your appetite and alter your taste perceptions and you will feel full after eating relatively small amounts. Second, there are often days when the technical demands of the climbing take priority, and the time for cooking is minimal. And third, conditions on bivouacs can simply make cooking difficult or impossible.
These problems can be ameliorated by having plentiful snacks that are a variety of savoury and sweet and that don’t require cooking; by making cooked food as quick to prepare as possible; and by having a stove system that is efficient and easy to use (e.g gas stove with hanging pots). From personal experience there is always a calorie deficit on the climbing days, but that this is made up by eating well during base camp rest days. I’ve shown a typical menu I use for camping above base camp, and if everything was eaten this would amount to around 2,200-2,500 calories per day. But in fact it’s rare to ever eat all these rations, and so calorie intake is even lower.
small bowl of cereal with powdered milk
couple of biscuits
2 cups of tea or hot chocolate
During the Day:
3-4 mini chocolate bars (e.g. Mars, Snickers)
1-2 muesli/grain bars
4-6 savoury biscuits with cheese
OR 2 chapatis with peanut butter
small packet 25g salted mixed nuts, or fruit/nut mix
1 litre fluids (e.g. isostar, tang, fruit tea with sugar)
1 cup instant soup
1/2 packet Maggi Instant Noodles
couple of biscuits
1 cup tea/coffee/hot chocolate
At base camp between climbing excursions I’ve observed that it’s usual to have a strong craving for fat and carbohydrates, and treats like egg and chips, pizza and pakoras are strong favourites. From this experience I would say having an experienced base camp cook is money well spent. In terms of where to buy base camp and high altitude food, due to weight restrictions on baggage and the hassles of freighting, I no longer try to buy any food at home but buy it all in markets in the destination area, often making the purchases with the help of a local cook. For further information on nutrition and very helpful information on hydration there is another useful factsheet from the UIAA medical commission - Nutritional considerations in mountaineering (www.theuiaa.org/medical_advice.html).
Finally, one of the best ways to get informed about all aspects of expedition life is just to talk to people who have already been to an area you want to visit. If you don’t know anyone personally, then you can turn to the library of on-line expedition reports, posted by the BMC (www.thebmc.co.uk/modules/expeditionreports/Default.aspx).
RelatedFor more Expedition advice and encouragement, why not check out our Expedition Climber Series:
Expedition Climber: An Introduction to the Greater Ranges
Expedition Climber: Getting started in Mountaineering.
Expedition Climber: Mera Peak
Expedition Climber: Denali.
Expedition Climber: Ama Dablam
Expedition Climber: Manaslu