Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Questions about Diamox

I'm not against taking Diamox, I'm just against taking it without getting a prescription from a physician experienced in high altitude medicine and caution folks against making medical decisions solely based on advice on this board. Just because you don't have adverse effects from Diamox doesn't mean that thousands of others don't.


You make my point - Excedrin has been safe and effective for millions of people yet it is not so for you. Others could have this kind of reaction to Diamox. Not something that you want to find out when you are at 11,000 feet and hours from medical help.



The FDA made these OTC drugs only after many years and millions of doses leading to the conclusion that they were safe enough to be taken without a physicians supervision. The fact that Diamox has not says that the FDA has not determined that yet (though it may be simply because the prescribing volume of Diamox is too low to get enough data).



Hmmm

ML,

I can't disagree with you more. The tipping point for me was a trip I took in 2000 that I spent two days acclimatizing at elevations above 10,000' going as high as 11,000' with absolutely no problems. On the third day we were standing on White Mountain, again, with no problems. Then a lightning bolt hit me, figuratively, nausea, fatigue, major headache and malaise. I had problems descending and these symptoms did not go away until I reached Big Pine.

I did not come to this without earning my spurs. I had problems on most every overnight trip over 11,000' and I was starting to have problems a low as 7,500'. I do not recommend anyone using this drug until a pattern of problems is established.

Believe me, this is not a performance enhancing drug, especially for a newbie trying to get the dosing right.

BTW SteveC, Diamox can make or break a Whitney Trip...I am walking proof of it.

As an optometrist, we learned about Diamox (a powerful carbonic Anhydrase inhibitor) in treating an eye disease called Glaucoma. Over the years it was used less and less, due to it's long term side effects. Newer Glaucoma medicines are just better then Diamox. Last time I bought some, I had to get it from a Canadian pharmacy since it was unavailable through our America Suppliers.

Diamox is not cheating (in the sense of performance enhancement) and will not make you stronger. With proper acclimation, it may help you not to get altitude sickness....but even with it some people still get sick.

Many people take Alleve on a 1 day Whitney hike, to prevent muscle soreness and prevent inflamation. That doesn't make you superman either.

Others concentrate on eating often and drinking much....to keep up energy level and prevent dehydration.

So I am not opposed to taking medicine if you need to....to help your trip be successfull. But if I saw someone walking along with an Oxygen breathing device....I would wonder?????? how I could get one. ......

Hi Kati,

There is no doubt good advice offered on these forums, but hopefully you are reading all the posts with a skeptical mindset. Very few of us are doctors, and there are very few doctors who are qualified with high altitude medicine (unfortunately, non-specialized doctors who climb recreationally themselves might end up with biased opinions based on their own climbing experience).

If you are interested in drugs, diamox is a good choice, but Steve's altitude page might be misleading: ginkgo biloba treats symptoms (or maybe not even that, as Steve correctly points out), not the cause. There are also other prescription drugs that help with HAPE and HACE (i.e. they might save your life, but they won't help you climb faster), although these should not be administered by an untrained person and can be dangerous.

For a definitive reference, I recommend Going Higher by Charles Houston (he is THE expert). He gives a thorough discussion of the subject of altitude, and also discusses doses.

And, since no forum post is complete without an unsubstantiated statement of personal opinion, here is mine:

I feel that most people in the continental United States should try to climb without a prescription medicine like Diamox. In most cases, altitude sickness is relatively mild, or goes away with increasing exposure to high altitude. I do not feel that it is appropriate to give it to your friend in order to allow the group to continue on.

I also feel that some people are exceptions. Certain people are more susceptible to the effects of altitude (regardless of their physical conditioning), and I would not think lesser if such a person took diamox. However, the drug should be prescribed by a physician after the person is convinced that they suffer abnormally from altitude sickness.

As I'm sure others have pointed out, getting in better physical shape and exposing yourself to altitude not only help with altitude, but also earn you more respect. In my opinion, these are sufficient for the majority of people in the Sierras/Rockies/Cascades.

Cheers,
Stephen

Although I do not claim to have medical training, after reading the book I referenced above, it seems that, in the sense of performance enhancement, Diamox IS cheating. It affects your blood's ph levels, allowing you to overbreathe (if you overbreath without diamox, you get too much carbon dioxide, which is absorbed into your blood and changes the ph).

You can get some of the benefit of diamox by forcing yourself to breathe at a faster rate than normal, but it will be hard to keep this up (and impossible at night).

Of all drugs for altitude sickness, diamox is the only one I know of that helps treat the cause (somewhat); all others treat symptoms.

-Stephen

When I am looking to buy a home, I say "location, location, location". When I am preparing to climb a mountain, I say, "acclimatization, acclimatization, acclimatization"!

MC

Here's a quote from something I wrote some time ago:

"Headaches are one element of the broader topic of acute mountain sickness (AMS). For the broader question, one paragraph in the paper is long but especially pertinent: “For the prevention of high-altitude illness, the best strategy is a gradual ascent to promote acclimatization. The suggested guidelines are that once above an altitude of 2500 m, the altitude at which one sleeps should not be increased by more than 600 m in 24 hours and that an extra day should be added for acclimatization for every increase of 600 to 1200 m in this altitude. For example, as compared with ascent to an altitude of 3500 m in a one-hour period, a gradual ascent over a period of four days reduced the incidence and severity of AMS by 41 percent. Most experts recommend prophylaxis for those who plan an ascent from sea level to over 3000 m (sleeping altitude) in one day and for those with a history of AMS. Acetazolamide is the preferred drug, and dexamethasone is an alternative; both are unequivocally effective; the dosages vary. The combination was more effective than either alone. Although controversial, small doses of acetazolamide (125 mg twice a day in adults) appear empirically to be as effective as larger doses, with fewer side effects; the minimal effective dose remains uncertain. In two controlled trials, Ginkgo biloba prevented AMS during a gradual ascent to 5000 m and reduced both the symptoms and the incidence of AMS by 50 percent during an abrupt ascent to 4100 m. With respect to headache, prophylactic aspirin (325 mg every four hours for a total of three doses) reduced the incidence from 50 percent to 7 percent. Reports suggest various Chinese herbal preparations might prevent high-altitude illness, but controlled studies are lacking. The notion that overhydration prevents AMS has no scientific basis."

That was from a 2001 Hackett-Roach paper. More is available at Medications for high-altitude illness?. A lot has happened in the intervening six years, for example I think the use of gilko biloba has been debunked.

Actually Stephen, being in better physical condition can make the AMS worse! When I was younger, I would train for big hikes by running sets up the stairs in a 7-story building. Talk about heart rate! I got it up to 220 once.

The result was that it enabled me to climb higher faster, and therefore resulted in worse AMS symptoms.

Note that Dr. Ken helped take a scientific survey of Mt. Whitney hikers last summer that included asking about their use of Diamox.

Have the results of that study been published?

So this thread is becoming a free for all. I'll jump in.

Some comments are in order, please:

Overbreathing blows off CO2.
Diamox does NOT make you overbreath. It makes you breathe more, yes, but appropriately more for the circumstances, this is normal for the circumstances. Big difference. The status quo has changed. One of the problems with altitude is that a persons' respiratory control system needs to be "reset". Very important. This is not voluntary and takes time and varies with people and situations. Yes, Diamox is a central respiratory stimulant. But it only makes you hyperventilate like you would normally do if you were properly acclimatized. Once acclimatized, it probably has little or no additional value. After all, most people who recommend it or use it themselves will stop it after 3-5 days at altitude.

Diamox promotes urinary excretion of bicarbonate to help maintain blood ph from becoming too alkalotic from loss of CO2 from hyperventilation. Again, this is not an abnormal or supraphysiological or cheating effect but merely and encouragement for your body to do what it should be be doing normally at that altitude. Some degree of alkalosis is good as it shifts the oxygen dissociation curve to the left.

Shifting the curve to the left is a physiological advantage used by bar-headed geese flying over the Himalayas (no kidding) as well as humans.

Honk honk, Harvey

Memory, thanks for asking.

I just got the manuscript in the mail last week from the lead author, and we hope to have it in one of the journals in the next year. (and you think GLACIERS move slowly...publication is another form of slow torture.....)

Here they are, but probably not shifting their curves to the left yet.

Edit: These birds are phenomenal! They have flown over Mt. Everest, their body heat keeps their wings from icing over, they circulate inhaled air through their lungs twice, and can travel a 1000 miles in one day. http://audubonmagazine.org/birds/birds0011.html
Thanks Harvey for mentioning them.

Everyone does what they can to make their Mt. Whitney trip successful. Most read, train and prepare. If they can they spend a few days in the area to acclimatize. Sometimes, based on problems with altitude in the past, they bring along Diamox.

I have been in many groups over the years, some with Diamox enhanced performance bodies. It does help in some circumstances, but it doesn't stop or prevent altitude sickness issues. It just delays them. If you are within 1000 feet of the summit you can probably stick it out with Diamox. If you are around 11000 feet, like at Upper Boy Scout lake, Diamox will not get you to the summit. The other thing Diamox does not do is make you faster and stronger then your fellow climbers. One's only hope with Diamox is to be able to continue.

This whole thing reminds me of this discussion I had with a guy who summited Mt. Ranier. I asked him what his secret was. He didn't say training or acclimation or eating right etc. He said the secret is "CoEnzyme Q10" I went to the health food store and read about the link of CoEnzyme Q10 and Energy. How do you get in without taking a pill. Eat Peanuts. So I guess the miracle substance is really just regular Trail Mix. Who knew??

Ken,

I know you are bound by legal ethics from disclosing the results prematurely but maybe we could impose upon you to let us all know when the report is published and how we can get to it.

I am hopeful we can start to understand more about the physiology which predisposes humans to AMS.

Also, thanks for enhancing what had been a boring thread until we got into a disagreement.

Ken, is this the follow-up study you did of this one?

http://www.whitneyportalstore.com/forum/...h=true#Post1453

Bob K - my pleasure to mention bar-headed geese. We have cell phones, Diamox, GPS, Bear cans, Gatorade, WAG bags, and whatever... whereas the geese just have the Right Stuff.

Harvey

Central nervous system: Ataxia, confusion, convulsions, depression, dizziness, drowsiness, excitement, fatigue, headache, malaise

I agree with this from personal experience. On my first Whitney trip, in 1999, I used diamox and we camped at Trail Camp. I felt fine to that point, but experienced confusion, drowsiness, fatigue and malaise in the morning. It was like one of those dreams where you need to get your act together to do something important and you just keep messing up. I could not get organized quickly as we were preparing to leave our tents and begin the summit leg. Wait a minute. That is the way I am all the time.

Denbo

Harvey, it is.

Memory, the deal in publishing is that we have to honestly state that the study has never been published anywhere else. These days, publishing on a public website is specifically included.
(sigh). However, there were no surprises, I thought.

Thanks for the correction about CO2 being decreased, not increased. By the aforementioned standard, diamox is still cheating -- it gets us to some state (i.e. being acclimatized) quicker than normal. It doesn't mean it's wrong, and the word "cheating" was just in response to seeing it used. But just because the final state is natural doesn't mean taking drugs to arrive there is natural. If one undergoes serious weight-loss for some reason and then takes steroids to build back his/her muscles to their normal state, the steroids are still not natural.

IMO, diamox is not good or bad -- and it's a personal decision. I'm not against taking supplements -- in fact, I find irritating when someone un-analytically bad mouths chemicals and drugs in favor of anything "herbal" or "natural". "herbal" does not always mean good or safe. Sorry for the irrelevant aside.

if you have to take drugs to climb a rock, stay off it


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