Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Ibuprofen reduces altitude sickness, US study says

The anti-inflammatory drug ibuprofen can reduce acute altitude sickness suffered by a quarter of the millions of Americans who travel to the mountains to ski or hike, according to a clinical study published Tuesday.

The rest of the article is here.

Thanks for the link.

A bunch of us swear by the 3-at-the-top rule (pills that is).

=================================================

This article is a big problem. I don't expect that people would neccessarily know these nuances, but there are a lot of problems with the interpretation of the data that is presented in the actual paper, and I do not think that it supports the conclusion that is being headlined. I'm a statistician, so I look at these things carefully.

For example, when you look at the actual numbers, there is NO statistical difference between the two groups in rates of headache, which is the basis of the LLC for determining altitude illnesses.

Another example. They state:



This is NOT impressive.

There was also another thing that was not really addressed: In the paper, they had a flow chart that showed how they split up the patients. In it they showed at the bottom, the number of climbers who required "rescue treatment" for AMS.

Quite interesting was that only 1 placebo patient required "rescue" treatment, but SIX patients required it
who were taking the Ibuprofen.

That is not success in my book, that is failure.

Additionally, they go on to say:



A clinically meaningful difference means something that actually makes a difference to a person, not just something that is a number on a paper. So what they are saying is that the difference that they observed would NOT, by their own definition, make a difference that the average climber would actually be able to tell.

They also say:



This is simply wrong. The effect of Ibuprofen as stated in their paper is minimal, in contrast to acetazolamide which is substantial.

Something that doesn't work is NOT an appealing alternative to something that ACTUALLY works!

Full article:

http://www.annemergmed.com/webfiles/images/journals/ymem/FA-gslipman.pdf

I take 3 pills at Trail Camp to give it time to absorb. I never go on a high altitude climb without ibuprofen and Vitalyte. No headaches or nausea, whatsoever. While I can't say this will work for everyone, I have tested this multiple times and it works well for me.

If I was more about quality than quantity, I would have explained that the pills are to aleviate (sp?) mild AMS symptoms and relieve the pain-in-the-legs that usually result from climbing these big Sierra peaks.

Getting on my Diamox Soapbox: if you don't have time for proper acclimatization (which in the case of Whitney would be about a week), you should be talking to your Doc about getting some.

Ask Shin, ask Scully, ask Tracie, ask Mouse, ask Carole. You'll probably get varied opinions (sp?) about the side-effects, but it does make going to altitude "fast" a slightly more pleasant experience.

All these things are very individual. I have side effects from Ibuprofen at any altitude, so I have never taken it for this purpose. I do take a small dose of diamox before bed if I am sleeping high to address periodic breathing. I have only once experienced an altitude headache (Kili, 16,000'), and it went away through aclimatization without Ibuprofen or aspirin (though I did increase my diamox dosage that one time).

Based on this discussion, think I will continue to do what I've always done: save weight by leaving the pills at home and feel just fine at 14K. (Big grin) If I ever get motivated enough to go to Mexico or Argentina, I'll bring some Diamox, just in case.

Yeah, rub it in Bob!

Having watched Rick Graham cruise up to 18K+, and knowing how much I would suffer with getting the acclimatization back (drug free) if I sat at home for a month, I envy you guys who can leave the pills behind... but I ain't ever going back to not using the aid of Diamox when I go high. (One year of suffering horribly and two with only mild symptoms down in Mexico has made me a believer.)

Ibuprofen has helped me with body and headaches to a degree. What has helped me the most is water. I've noticed (and suffered) for the lack of it.

I like Richard's 1-week rule for Whitney too.

Myself, like Ken, looked at this study with an eye of skepticism and saw the conclusions drawn were overly optimistic to say the least. The first, and the biggest problem, I had with the study was sample size. 86 participants, although seemingly adequate to most, is hopelessly too small to draw any meaningful conclusions from. The researchers made a valiant effort to screen the participants in an effort to provide unbiased data but fell hopelessly short primarily due to the lack of understanding of what exactly predisposes a person to AMS. For example why does one person who is in top physical condition get AMS and another, more sedentary, person does not? Genetics? Exposure to some unseen environmental factor? Diet? We don't know for sure. Like Ken, in my opinion, the data does not come close to supporting ANY conclusion, let alone the the researchers came to. The study therefore is little more than a well constructed testimonial and has very little valid substance, IMO.

The take home lesson for me is to continue to take ibuprofen for as an anti-inflammatory and, when appropriate, take acetazolamide for those times when a proper acclimatization schedule is not possible.

I think Ken and John hit the nail on the head. In addition I'd like to remind people that masking mild symptoms of AMS and pushing on up the hill isn't generally a good game plan. If I get a headache, shortness of breath (beyond what I expect from the exertion), nausea, weakness, etc., I take it as a warning and rest and/or go descend before HAPE or HACE develops.

I side with Richard P. - if you consider all that "might" happen, you may want to stay safe in your house, otherwise, make life a challenge...

"Testing one's limits may create a risk factor but it is the only way to find out what you are truly capable of." mc reinhardt

I don't want people to think I am coming out against vitamin I (as we call it), which I use liberally myself.

I am certainly not opposing my friend Richard, whose practices are tried and true.

My issue is with the article, and what it says, and what it implies that people should do.

I think it is troubling that people would think that they can skip acclimatization and simply take ibuprofen....and some people will do exactly that. That is what the headline suggests, and that is wrong.

Ken's first post details the flaws in the study, and when I read the newspaper account I was immediately struck by the large altitude gain in one day. Beginning at 8AM, they began climbing (4,100') and reached 12,750' within 12 hours, a gain of 8,470', which is a LOT of gain. Without knowing more details about their conditioning programs, what weight they carried, etc, my instincts suggested it was another piece of pseudo-science.

I have been following all these post. I am in healthcare. We don't consider a study valid if it doesn't have at least 250 subjects. I don't even both to read a study unless there are 250 subjects. Just my 2 cents.

Kev, you are being kind.
A whole bunch of stuff these days is junk science

Just wanted to let everyone know that one of my patients very recently developed renal failure as a result of daily high dose ibuprofen (I'm a pharmacist). He's ok now after discontinuing. In talking with another clinical pharmacist, he informed me that incidence of renal failure is not uncommon (drawing upon his experience in our local hospital) and is actually surprised it isn't higher given the OTC status ie. availability, perceived safety of ibuprofen.

Good info, John! There is a tendency to think that because something is OTC, it is always safe.

It is worth noting that chronic, long-term use on a daily basis is vastly more likely to produce problems, than short term use. Also, high dose (anti-inflammatory) dosages mean that you are using OTC's at a much higher dosage than advised on the box. For advil, it would be in the range of 16 pills a day. That keeps a lot of people out of trouble, because most people won't take that volume of pills.