Hacking Altitude Sickness/Acute Mountain Sickness (AMS)

I haven't seen any discussions specifically on avoiding altitude sickness so I am starting this post to list what I've learned and to seek additional information/tips/hacks. I am by no means an expert, but just gathering all this information in one place.

I am climbing Kilimanjaro soon and have been researching ways to lessen or avoid getting altitude sickness beyond drinking a ton of water and going SLOW. I've read 60% of people don't summit and 70% of trekkers experience some degree of altitude sickness.

Diamox (Acetazolamide)
Diamox is widely-recommended as a prophylactic medication for persons on forced rapid ascents or those who can't avoid large altitude gains without acclimatization. Most people who have a reasonable ascent schedule will not need it. You need a prescription for Diamox. Along with begin a diuretic, there are some unpleasant side effects as well as the risk of any of the severe side effects that may occur with sulfonamides. This drug may reduce the potassium levels in your blood.
Recommended Use: 125-250 mg (depending on body weight; persons over 100 kg (220 lbs) should take the higher dose) twice a day starting 24 hours before ascent, and discontinuing after the second or third night at the maximum altitude (or with descent if that occurs earlier). Children may take 2.5 mg/kg of body weight twice a day.

Dexamethasone (Glucocorticoid)
While I see this recommended on a few sites, there is usually strong disclaimers regarding use of this drug. It decreases your body's natural defensive response and reduces symptoms such as swelling and allergic-type reactions. Climbers see benefits by lessening or masking the symptoms of altitude sickness, but I need not find great reviews. Sounds like it is good to have for emergencies. Need a prescription.
Recommended Use: Consult with your doctor.

Vitamin C
Rats dosed with vitamin C can endure higher altitudes in lab simulations. People probably can too. So consider regular doses of Vitamin C for the duration of their stay. How much, I've heard anywhere from 500 mg (which I think was what Petzoldt talked about) to 10,000mg/day from Dr Randall Bradley of Nebraska.
Recommended Use: Vitamin C 2-3,000 mg/day

Vitamin E
Vitamin E may benefit altitude sickness. Antioxidant supplementation (vitamin E with beta-carotene, vitamin C, selenium, and zinc) may improve breathing at high altitudes. However, antioxidants may not reduce inflammation after exercise at high altitudes. More research is needed.
Recommended Use: 400 iu/day

alpha lipoic Acid
Lipoic acid has protective effects on the brain, the heart, and much more.
Recommended Use: 150-300 mg/day

Ginkgo Biloba
Thirty-six participants who reside at sea level were transported to an altitude of 3696 m (Ollagüe). The participants were divided into 3 groups and received G biloba (n=12) 80 mg/12 h, acetazolamide (n=12) 250 mg/12 h, or placebo (n=12) 24 hours before ascending and during their 3-day stay at high altitude. A significant reduction in AMS was observed in the group that received G biloba (0%, P<.05) comparison with the groups receiving acetazolamide (36%, P<.05) or placebo (54%). No difference was observed in arterial oxygen saturation in the G biloba (92+/-2) vs the acetazolamide (89+/-2) groups. However, a marked increased saturation in arterial oxygen was seen in comparison with the placebo group (84+/-3, P<.05).
Recommended Use: 120-180 mg/day I've heard pre-dosing for 10-5 days prior to your expedition.

Milk Thistle
A plant flavonoid and hepatoprotective properties of milk thistle are attributed to its antioxidant
properties and has a positive effect on altitude sickness.
Recommended Use: 120-240 mg/day (any liver complaints)

Glutathione is quickly depleted at altitude making the body susceptible to the many forms of damage it normally protects one from. Many of the symptoms of altitude sickness appear to be related to free radical activity and a number of studies have used antioxidants to decrease the effects. Glutathione is considered the body's master antioxidant.
Raise glutathione levels: Selenium 200 mcg/day, N-acetyl-cysteine 1-2000 mg/day

Adding glutamine has a protective effect. Rats fed doses that in a human would be equivalent to about 2-3 grams a day were 4.5 times as resistant to hypoxia than non-treated rats, more resistant to cold and were able to gain weight at high altitudes. This may be because glutamine helps replenish the glutathione levels. If so other substances that help produce and protect glutathione in the body may also be useful. Glutamine is considered a conditionally essential amino acid. Under certain conditions of especially physical stress the body isn't able to manufacture this amino acid in adequate amounts to keep up and supplementation is useful.

Cataplex E2
It is a proprietary formula manufactured by an old nutritional company called Standard Process. Cataplex E2 contains vitamin E and selenium. Cataplex E2 somehow increases the ability of red blood cells to deliver oxygen to the tissues. Standard Process only sells through health practitioners.

ChlorOxygen chlorophyll concentrate increases the amount of oxygen available to cells. It supports the production of red blood cells and its blood-oxygen carrying capacity. It boosts energy levels. ChlorOxygen is helpful for individuals traveling to or living in high altitude locations. It also supports digestive and intestinal health and ensures a healthy liver.
Recommended Use: 100mg/day

In BP Podcast episode #95 "Hacking Your pH, LED Lighting & Smart Drugs Part 2", Steven Fowkes mentioned using piracetam for altitude sickness. Has anyone experimented with this?
From the transcript- Steve: "It’s a good remedy for altitude sickness. Anybody who gets light-headed or sleepy on airplanes, they crash into trees while they’re skiing, piracetam is very, very helpful for that. I used it once on a trip to central Utah when I was at 8,000 feet. Normally, at that altitude, I’d be light-headed."

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Kumar D, Bansal A, Thomas P, Mongia SS, Sharma SK, Sairam M, Grover SK, Singh MV, Prasad D, Ilavazhagan G, Selvamurthy W.Improved high altitude hypoxic tolerance and amelioration of anorexia and hypophagia in rats on oral glutamate supplementation.Aviat Space Enrion Med 1999 May;70(5):475-9
Kelly GS. Rhodiola rosea: a possible plant adaptogen. Altern Med Rev 2001 Jun;6(3):293-302
McKenna DJ, Jones K, Hughes K. Efficacy, safety, and use of ginkgo biloba in clinical and preclinical applications. Altern Ther Health Med 2001 Sep-Oct;7(5):70-86, 88-90
Schreiber M, Trojan S. Protective effect of flavonoids and tocopherol in high altitude hypoxia in the rat: comparison with ascorbic acid. Cesk Fysiol 1998 Jun;47(2):51-2


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