Why altitude matters to pilgrims
Many of the most important places in Himalayan and Tibetan Buddhism lie at heights where the air holds noticeably less oxygen than at sea level. Lhasa is at roughly 3,600 metres. Parts of Ladakh, including Leh, are at a similar level. Monasteries and villages in Nepal’s high valleys, in Sikkim and in Bhutan can be considerably above 3,000 metres, and passes on trekking routes and pilgrim circuits reach well above 4,000 and even 5,000 metres. The kora around Mount Kailash, for example, crosses a pass commonly cited as over 5,000 metres.
Pilgrims are often not trekkers by habit. They may travel in groups, fly or drive rapidly to height, be older, and feel moved by the occasion to push on. These are all reasons why altitude deserves attention. This article is general information, not medical advice. Altitude illness can be serious and sometimes life-threatening, and a doctor or travel health clinic should be consulted well before any high-altitude trip.
What altitude illness is
As you go higher, each breath contains less oxygen. The body adjusts over days, through changes in breathing and in the blood, a process called acclimatisation. Altitude illness happens when the body does not adjust quickly enough to the altitude reached. It is generally discussed as three related conditions:
- Acute mountain sickness (AMS) is the most common and mildest form.
- High-altitude cerebral oedema (HACE) involves swelling of the brain.
- High-altitude pulmonary oedema (HAPE) involves fluid in the lungs.
The latter two are medical emergencies. Who gets sick is difficult to predict. Fitness does not guarantee protection, and someone who has been fine at height before may still become ill on another occasion. Risk is commonly linked to how quickly one ascends, how high one sleeps and individual susceptibility. People often begin to notice effects from about 2,500 metres, though this varies from person to person.
Warning signs
Early symptoms of AMS are often compared to a hangover or flu and can include:
- headache, the most typical symptom
- nausea or loss of appetite
- dizziness or light-headedness
- unusual tiredness
- poor sleep
More serious signs, which need urgent attention, include confusion, unusual behaviour, loss of coordination (for instance, difficulty walking in a straight line), severe or worsening headache, persistent cough, breathlessness at rest, a rattling or gurgling in the chest, or drowsiness that is hard to rouse. Do not assume such signs are due to tiredness, and do not ignore them in a travel companion who dismisses them. Because symptoms can be mistaken for stomach illness, dehydration or simple fatigue, a doctor’s guidance beforehand on what to watch for is valuable.
The key principles
Medical advice on altitude tends to share a few core ideas. They are summarised here to explain the concepts, not to replace advice from your doctor.
Ascend gradually. The most widely repeated advice is to avoid going up too fast. Many sources suggest that, once above about 3,000 metres, the height at which you sleep should rise slowly from night to night, with rest days built in. The exact numbers are debated and depend on the individual, so discuss specifics with a clinician.
Rest and acclimatise. On arrival at a high place such as Lhasa or Leh, many travellers are advised to take it easy for the first day or two. Overexertion, heavy meals and alcohol are commonly discouraged early on. A schedule that includes time to adjust before visiting higher monasteries is sensible.
Do not go higher with symptoms. A common rule is that if you have symptoms of AMS, you should not ascend further until they have gone. If symptoms are getting worse, go down.
Descent is the most important treatment. For serious altitude illness, descending to a lower elevation is generally the key response, along with urgent medical care. Delay is dangerous.
Know your options. Some doctors discuss medicines that may help prevent or treat altitude illness for certain travellers. Whether any medication is suitable depends on health, allergies and other drugs, so this is a question only a doctor or travel clinic can answer. Do not take or share medicines without proper advice.
Specific situations in pilgrim travel
Flying into a high place. Arriving by air in Lhasa or Leh takes you from low to high in hours, with no gradual adjustment. This is a well-recognised situation in which people are affected. Plan for easy first days and read about the sites you hope to visit, such as the Potala Palace, which involves many steps.
Road journeys. Overland routes in Tibet and the Himalaya often cross high passes and then descend, so sleeping altitude and the highest point reached may differ. Pay attention to where you will sleep each night.
Circuits and treks. The Kailash kora, Himalayan pilgrimage treks, and circuits such as the Manaslu Nubri gompas and Annapurna Circuit monasteries routes all involve climbing high, and many are remote. Evacuation can be slow, and some routes are far from medical care. See preparing your body for long pilgrimage walks for fitness advice, and note that insurance often has altitude limits, as discussed in the article on pilgrim travel insurance.
Sacred lakes and high plateaus. Sites like Namtso are visited in a day by some groups from Lhasa, yet sit much higher than the city. Namtso visit altitude gives more context.
Older travellers and those with health conditions. Heart and lung conditions, anaemia, some other medical problems and pregnancy need particular care, and many travellers will want to discuss whether high-altitude travel is advisable at all.
Children. Children can be affected too and may find it hard to describe symptoms, so extra watchfulness is required.
Practical habits
- Drink fluids regularly, since dry high-altitude air and increased breathing cause fluid loss.
- Eat light, regular meals and keep warm; cold, discussed under cold weather pilgrimage, adds to fatigue.
- Avoid or limit alcohol and sleeping pills early on, and ask your doctor about any regular medication.
- Do not travel alone in remote areas, and tell others where you are going.
- Be honest about how you feel, and make it easy for your group to speak up. In groups with a fixed schedule, there is often social pressure to carry on, so agree in advance that anyone can call for a rest or a descent.
- Allow extra days in your itinerary so the schedule does not force a risky choice.
Respect and caution together
In Tibetan Buddhist tradition, circumambulating and visiting sacred places at height is a deeply meaningful practice. It is also true that no tradition asks anyone to endanger their life. Descending, resting or skipping a pass is a sensible decision, not a spiritual failure. Rules, permits and conditions in these regions change, so check current official and medical advice before and during your journey. Outcomes at altitude are uncertain, and preparation cannot remove the risk entirely.