Everest Express: acclimatizing at home

Is it possible to climb Everest in three weeks or Manaslu in a fortnight under acceptable margins of safety? The short answer is yes, it is, as long as climbers find the right way to pre-acclimatize while at home. The use of hypoxic tents and masks is granting some impressive results. But – here comes the “but – DIY solutions and standard programs may or may not work and, in the latter case, you will only find out when it’s too late and the air is too thin.

Training in conditions of hypoxia is not new for elite athletes. The method has been used for decades, mainly aiming to enhance performance by increasing the hematocrit levels (number of red blood-cells), which results on a more efficient transportation of oxygen though the human body’s tissues and a better ventilatory response. The same process occurs naturally when the human body is forced to perform at higher altitude.

However, such gain in height must be done progressively and carefully, so that blood gets “thicker” without triggering the formation of blood clots, or developing Pulmonary/cerebral edema (liquid swamping the lungs/brain), the most usual symptoms of the so-called Acute Mountain Sickness (AMS). If the process unfolds properly, the subject will “acclimatize” to thinner air conditions. On the contrary, AMS is a life-threatening condition which requires immediate action.


Acclimatization requires patience and time

Acclimatization differs from one person to another and from case to case. Since there is no magic formula, the process is done by gaining altitude slowly and progressively, observing one’s state constantly and being ready to return to lower grounds the moment O2 saturation starts decreasing o AMS symptoms start appearing. Acclimatization requires patience and time, so climbers on high-altitude expedition must be ready to invest weeks, make several rotations up and down the mountain and check on their state daily.
This is basically why Himalayan expeditions take months. Or used to.

Playing tricks to Thin Air

In these hectic times, every minute counts – and cost money. The fierce market around Himalayan expeditions has swiftly responded to such demand and, while outfitters cannot control the weather and conditions on the ground, they are willing to invest on those elements helping to minimize the time spent on a mountain, in order to attract clients with tight deadlines and wide wallets. Two resources come handy for the task:

The first one consists of increasing the supplies and flow of supplementary Oxygen. Cutting-edge oxygen systems can increase the maximum flow of O2 from the usual 4 liters per minute to 6 or even 8 liters. Larger expedition staffs can multiply the number of bottles carried up and stacked along the mountain. The usual 1:1 Sherpa rate in the top-end commercial expeditions in Nepal has also doubled, so each client may count of one Sherpa fully devoted to carry their O2 up and down during the summit push.

Yet, trusting solely on bottled O2 involves a significant risk. If something fails up on the mountain (the mask, the regulator, or the supplies) the climber will be suddenly left exposed to the suffocating reality of the death zone and, the wider the difference between the gas sipped and the real conditions, the fastest AMS, frostbite and then death will overcome them. The fact came tragically obvious on the south side of Everest in 2019, when climbers were caught in a jam at the ropes fixed on the Hillary Step and started running out of gas, with no option to move down and fetch more. Ten people died only on May 22nd, none of them involved in mountain accidents.

the method involves getting climbers
pre-acclimatized in advance

The second method involves getting climbers pre-acclimatized in advance. Here, the hypoxic training enters the scene.

The idea is to reproduce somehow the conditions of thinner air while at lower altitude by, either spending time in a hypoxic tent, or training with a masks which takes away part of the oxygen as you breath in. This method has been tested on Everest expeditions since the 1990s but it is the production of new portable devices that is turning the method, according to experts, into a growing trend.

Terra XCuve Eurac. ©TerraXCuve/Pavana

Tamara Lunger and Simone Moro acclimatizing in Terra XCuve. ©TerraXCuve/Pavana

Hypoxic VS Hypobaric

The main problem in this kind of training is that you reduce the among of O2, but not the pressure,” Dr. Iñigo Soteras, a rescue physician, responsible of health area in the Spanish Climbing federation and member of the UIAA’s Medical Commission, told AlpineMag. “The problem at high altitude is not so much the amount of O2, but the air’s low pressure.”

To really replicate high-altitude conditions, the ideal training should take place in not only hypoxic, but also hypobaric conditions. Such was the case of the TerraXCube chamber in Eurac Research premises in Bolzano, used by Simone Moro and Tamara Lunger before attempting the Gasherbrums in winter. Some similar displays are found at some high-performace sport centers, but they are usually not available for the average Everest climber.

More popular are the displays designed to create and control conditions of hypoxia. These are easier to use, portable and increasingly popular both to trigger the acclimatization process and to enhance performance in endurance sports. They have several medical uses such as treatment of respiratory complications, as those caused by COVID.

Recent studies have demonstrated a reduction in AMS incidence during high altitude exposure after various intermittent normobaric (not hypobaric) hypoxia protocols,” the UIAA’s medical commission stated. “But, intermittent normobaric hypoxia seems to be effective only if the hypoxic exposure amounts to >1 to several 100 hours distributed across several weeks to months.”

Altitude tent. ©Hypoxico.eu

There’s also an ethical dilemma

Moreover, playing with hypoxia at sea level could have some serious side-effects “such as thromboembolic events in high-risk subjects, particularly after a long travel from Western countries to Nepal,” the UIAA’s added. “Subjects with unknown pre-existing medical conditions such as coronary artery disease may not well tolerate hypoxia during nighttime.”

Those considering using hypoxic masks or tents undergo a complete medical checkout in advance, in order to identify pre-existing conditions that could trigger cardiac or vascular problems,” Dr. Soteras noted.

Finally, in the UIAA’s opinion, it is still unknown what is the optimal intermittent normobaric hypoxia protocol. The training efficiency varies greatly from person to person.

There’s also an ethical dilemma,” Dr. Soteras reflected. “I wonder if, through that kind of training, we might be opening the gates of high-altitude climbing to people with limited training and experience in high-altitude conditions who, with a classic approach, might not get that high up for a number of reasons.”

The lack of a standard protocol is also noted by Steve House on his Uphill Athlete training portal. In an article on the topic, House lists pre-acclimatizing in a normobaric hypoxic sleeping system as one of the 11 factors contributing to succeed on high altitude expeditions, but he remarks it is essential to remain time enough in the chamber (8 hours out of every 24). In his opinion, it is difficult “to train hard enough to be gaining fitness while sleeping in a tent over the approximate altitude equivalent of 10,000 feet,” as was the case with the late Ueli Steck and David Göttler, who couldn’t keep their usual workloads when sleeping in altitude tents. He also notes lack of scientific evidence. Still, House admits results change from person to person and assumes that athletes and their coaches may figure out a training program that works for them.

The late Sergi Mingote during a Hypoxic training session. ©Mingote

The “flash” Everest outfitter

The personalization factor key for Lukas Furtenbach of Innsbruk. His international expedition outfitter Furtenbach Adventures has pioneered fast expeditions to 80000ers. FA offers “flash” Everest climbs since 2016 and currently includes the pre-acclimatization option on all the 8,000rers he organizes expeditions to. Since 2018, FA commits to have their clients climb Everest in three weeks and Manaslu in two. Whatever the scientific evidence on peer-reviewed works, Furtenbach shows a flawless 100 % success rate.

Furtenbach came with the idea after being himself a test-subject on a major research work on the use of hypoxia in enhance performance in endurance athletes at Innsbruck University. Then he tried the hypoxic training himself and tested it further with the company’s guides as guinea pigs, before launching a first fast climb to Broad Peak in 2008. Since then, they have been constantly improving the equipment and, most of all, optimizing the monitorization of climbers before and during the expedition.

The key to hypoxic pre-acclimatization training is to remain for the right time at the right (simulated) altitude before heading for the actual mountain,” Lukas Furtenbach told AlpineMag. “There is no standard program that works for everyone. The acclimatization processes vary on each individual and the only way to find with the right protocol is by adjusting all parameters constantly, which only be done by monitoring the person day by day.”

In addition, all “flash” clients are required to provide a complete medical checkout and reports on their training background – and the atmospheric conditions of the place they live: altitude, pressure data, temperature, etc. “The program will differ for a person living in Colorado or Florida,” Furtenbach said.

©Furtenbach’s Instagram

As the training program start, the climbers send us daily data: VOS2, how much time they spent in the tent, etc… Based on these data we give them the instructions about what to do in the following hours. This must be maintained during the whole acclimatization period which, in the case of Everest, may be 6-8 weeks, 5-6 weeks for Manaslu, but will vary, depending on the person and their specific goal (time available, previous experience and fitness, use or not of supplementary O2, etc.)”

Furtenbach also noted that the human body develops a kind of acclimatization memory though subsequent expeditions, so the more expeditions someone takes part in, the fastest or the more efficiently he is going to acclimatize. “Someone climbing in altitude for the first time will need much more hours in the hypoxic tent than myself, for instance, who might be okay with two or three weeks not to get AMS,” he said.

In the end, it’s up to us to find the right program for each person. The lack of it actually constitutes the main reason why the use of hypoxic tents fails for some people: standard programs that might work better or worse, or not at all.”

The Austrian outfitter ensures any healthy person could use this method. “Acclimatizing with a hypoxic training is not different from acclimatizing in a base Camp,” Furtenbach said. “It has exactly the same effects on the body.”

While several sport-related companies offer intermittent hypoxic training programs, FA is the only expedition company which implements the entire “package”, from the pre-expedition training to the fully serviced and fully monitored expedition. They have a nutrition program to complement the training before and during the climb, a medical team checking on the clients from the first day of pre-acclimatization, a medical doctor in Base Camp, VSO2 sensors that climbers have on during the summit push, daily ultrasonic screening, etc.

Then, the question is – is it possible to complete a “flash” climb without O2. It is – Furtenbach replied – but only for fit enough climbers, but in addition to sleeping in an altitude tent, they will need to train in hypoxia with the masks. “We had a client who climbed k2 without O2, completing the round trip from and to New York City in just 21 days,” Furtenbach recalled. “He was an investment banker, not a professional climber, but indeed a very fit person.”

Obviously, those considering joining FA for a fast Everest experience will need something else than fitness. Flash expeditions are more expensive than the classic ones. In 2021, “Flash Everest” is $99.000 while the classic, longer expedition to the roof of the world is offered at $61,000. The group for spring 2022 is nearly fully booked.

Want to acclimatize at home ? Choose your program !

Straight from the horse’s mouth

So, what is it like to get to Everest Base Camp after acclimatizing at home while sleeping? French Gabriel Picard was a member in FA’s Flash expedition to Everest’s north side in 2019 and tags the process as “perfect”. The team needed just three weeks from the day they reached Base Camp in Tibet, to summit and back to BC. “Three days after reaching BC I climbed to the North Col (7,000m) and spent a night there – without O2, so it’s clear I was well acclimatized; and it really felt like that,” he said. “Then we waited a week for a good weather window and, when it came, we pushed for the summit,” he said. “I used always low flow of O2, 1l/min from the North Col, 2l/min from Camp 3 (8,300m) and a bit more on the last section, above the “steps” (aprox. 8,600m); then, on descent, I stopped using O2 at Camp 3.”

Picard is an experienced alpine climber and a former mountain instructor in Chamonix, but his only previous high-altitude summit was Aconcagua, summited 4 years before. Back then he did the full tour and followed a conservative, classic acclimatization process, but recalls he never felt well acclimatized and, overall, felt the climb was harder than Everest itself. “However, I have to bear in mind that that was my first high-altitude experience, everything was new to me,” he said. “It was an good preparation: I learnt a lot on the expedition about what it means being on high altitude, and it helped me a great deal later on Everest.”


Gabriel Picard during his Everest ascent. ©Picard

Gabriel Picard on Everest summit. ©Picard

Picard explains he firstly chose the “flash” expedition option for reasons of agenda, but the pre-acclimatization overpassed his best expectations. Funny enough, he is not so keen about returning to the 8,000ers. “The reason to climb Everest is that, since I was a child, I had read about Mallory and Irvine, Messner… I wanted to live my books, see what it looked like, what it felt like, “ he said. While happy with the experience, Picard hopes to climb again in the Himalayas, but aims for a different kind of expedition. “I would really like to climb a lonelier mountain, not so tall but more technically challenging,” he said. As for if he would use again the hypoxic pre-acclimatization method, he said: “Definitely, yes.”

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