How to see Peru without getting altitude sickness
You should see Machu Picchu and other parts of the Peruvian Andes at least once in you life. Seeing the ruins for the first time brought tears to my eyes (yes, even me, the jaded travel writer).
But once-in-a-lifetime trips must be planned properly, especially ones where doing it the wrong way can make you sick.
I met many people during my trip to Peru’s Machu Picchu, Cuzco and Lake Titicaca who were affected by altitude sickness. All of them had visited the Peruvian highlights in the wrong order, and tried to do too much without allowing their bodies to acclimate to the altitude.
First, the science lesson
Here’s what some key altitudes look like:
|Location||Height in Meters||Height in Feet|
|Everest base camp||5000m||16 000 feet|
|Highest point on the Inca Trail||4200m||13 780 feet|
|Puno / Lake Titicaca||3812m||12 507 feet|
|Cuzco||3400m||11 150 feet|
|Urubamba Sacred Valley||2863m||9 420 feet|
|Ollantaytambo Scared Valley||2792m||9 160 feet|
|Start of the Inca Trail||2750m||9 000 feet|
|Huayna Picchu||2720m||8 920 feet|
|Machu Picchu's Sun Gate||2700m||8 850 feet|
|Altitude sickness possible above||2438m||8 000 feet|
|Machu Picchu||2430m||7 972 feet|
|Oxyhaemoglobin levels in blood begin to drop||2100m||7 000 feet|
|Aguas Calientes (Machu Picchu base town)||2042m||6 700 feet|
If you travel to the Peruvian Andes, you will be affected by the altitude. The key is to not get altitude sickness.
Just by visiting a high altitude for the first time, you will huff and puff on inclines, your heart will race, and you feel more tired than normal. To minimize this and, more importantly, make sure you don’t get sick, you will need to adjust to altitude slowly, and work your way from lower to higher altitudes. It takes about three days to adjust to any given altitude; and takes about 45 days to fully adjust to being at an altitude of 4000 m.
Yes, altitude sickness is serious. It will ruin your holiday if you can’t get out of bed, have distorted vision, headache, difficulty thinking clearly, or if you’re vomiting. It will ruin much more than that if you have heart failure or cerebral or pulmonary edema. These will kill you if you don’t get to a lower altitude quickly enough.
So, have I proven to you that you want to plan your trip to avoid altitude sickness? Thought so. Alright, here’s the way to see Peru without getting sick.
Arrival in Lima
Most people arrive in Peru in the capital, Lima, which is just a few meters above sea level. If you are travelling a very long way and/or are very prone to jet lag, I would suggest starting your trip with a short rest in Lima. It will be easier to sleep and get your clock re-arranged at sea level than it will be at altitude. You could also save Lima until the end of your trip, so that you have a chance to rest after the more challenging Andes — you don’t want to return home from your holiday needing a holiday!
Where to stay? Miraflores is the best neighbourhood for first-time visitors to Lima. It is amongst the safest and it is more European / North American than many other neighbourhoods in this third largest city in the Americas. There are ample hotel, restaurant and shopping choices, and you’re on the cliffs above the surfers on the Pacific. I enjoyed the relaxed atmosphere and especially the breakfasts at Casa Inca, which is half a block in from the park and promenade along the coast.
Go directly to the base of Machu Picchu (Aguas Callientes) and stay three nights
Many people think it best to acclimate first in Cuzco, and then head to Machu Picchu. This is a mistake. Cuzco is at a much higher altitude than is the lost city of the Incas. One exception: if you are planning a multi-day hike along the Inca Trail, then yes, you need to acclimate first, ideally starting in the Sacred Valley and then in Cuzco.
But if you are just going to visit the site of Machu Picchu itself, then your plan is easier. You should go directly from the Cuzco airport to the town of Aguas Callientes, which is only 2042 m (6700 feet) above sea level. You will feel the altitude, but you are unlikely in any danger of illness. To get there, take a taxi from the airport to the town of Ollantaytambo, and then take a train to Aguas Calientes. Or you can take the train the entire way from Cuzco. The early morning trains toward Machu Picchu are the busiest; you’d be wise to buy your train ticket in advance.
I recommend three nights at the Sumaq Machu Picchu in Aguas Callientes. Upon arrival, have dinner (included in rates) in their excellent restaurant. Get a good night’s sleep and on your first full day, take advantage of the hotel’s pisco sour and ceviché class, and learn how to make these Peruvian specialities. Explore Aguas Callientes a little (essential: wear bug spray and cover your ankles) and let your body start acclimating. If you haven’t bought your Machu Picchu tickets yet, you can buy them in town (though for high season — June, July and Christmas — you should book in advance).
The next day should be your Machu Picchu day. Because you are at the base of the ancient city, you can easily be amongst the first in line to catch the bus up to Machu Picchu (essential if you want to see the sun rise, or to climb Huayna Picchu, for which you need an extra ticket). Sumaq Machu Picchu can arrange your bus tickets for you and recommend how early you should be at the bus stop for the 20 minute ride.
After your day tramping the ruins, you could take the train out of Aguas Calientes. But you need to book your train ticket in advance, and it might be hard to predict how long you will want to spend exploring Machu Picchu. For this reason, I recommend a third night in Aguas Calientes. Plus, you’ll feel so much better if you can return to Sumaq, have a hot bath in their jacuzzi tub, and sleep in their comfortable beds with the sound of the river in your ears.
The next day you can sleep in, rest your feet and return on the train at your leisure.
Stop in the Sacred Valley
You can take the train just to Ollantaytambo, to Urubamba, or all the way back to Cuzco. To further acclimate as you climb higher in altitude, plus see the sites in the Sacred Valley, I recommend at least a two-night stop in Urubamba, which is 2863 m (9420 feet) above sea level.
One of the nicest hotels I tested in Peru was in Urubamba — Tambo del Inka, one of Starwood’s Luxury Collection hotels. The hotel even has its own convenient train station. (Yes, you could stay here and see Machu Picchu too, but because of the train schedules you won’t be able to arrive to see the sun rise over the ruins and you’re likely to miss your window to climb Huayna Picchu, if either is important to you).
I recommend you enjoy Tambo del Inka’s wonderful spa services and gorgeous swimming pool after seeing Machu Picchu, and explore some of the ruins and sites in the Sacred Valley. The ruins at Ollantaytambo are the most impressive, but there are a number to choose from. You will need a ticket to see them — either a 2-day “mini-ticket” giving access to four specific Sacred Valley sites, or the 10-day 12-site “big ticket” which includes sites in and around Cuzco. A taxi is the best way to see all four Sacred Valley sites; you could squeeze three into one day if you needed to (but then you wouldn’t have time for Tambo del Inka’s spa!).
Then explore Cuzco
Now you can take the train or a taxi back to Cuzco’s 3400 m (11 150 feet) altitude. No headaches or vomiting for you! You will need to walk slowly up Cuzco’s steep streets, but your body will be prepared for Cuzco since you spent a few days in Aguas Callientes and in the Sacred Valley.
I’d recommend at least four nights to get a good taste of Cuzco and to see some of the sites included in your “big ticket”. We’ll soon publish another article on the sites of Cuzco and recommend places to stay (El Mercado Tunqui, Andean Wings, Casa Encantada) and to eat (Bojosan Japanese Udon Bar and Le Soleil Cuisine Française) — stay tuned!
Last stop: Lake Titicaca
Lake Titicaca is the highest altitude most tourists reach in Peru, and it is high. At 3812 m (12 507 feet), this is the highest navigable lake in the world. The air is noticeably thinner (and drier) here than in Machu Picchu and Cuzco. The daytime sun is strong (don’t forget your sunscreen!) and the nighttime temperatures are freezing (as low as minus 7C (18F) in July).
The lake’s waters are a beautiful colour and visiting the floating islands is a treat. Plus the name makes people giggle. Island inhabitants will show you how they make and maintain the floating “land” their homes are built upon, and give you some insights into their unique lifestyle. Walking on the islands feels a bit like walking on a spongy trampoline — I’d love to read a study on how living on the islands affects the locals’ bone structure, muscle development and height, compared to those of us who spend our days on hard flat surfaces.
You can fly from Cuzco to Juliaca in an hour (or, if you have time, take the 10 hour train trip!). Hotels will arrange transfer for you from the airport (one hour), most are located in and around the small city of Puno. I stayed at Taypikala Hotel Lago, a Peruvian-owned and operated hotel right on the edge of the lake. The views are beautiful and Taypikala is a relaxing stay away from the somewhat gritty Puno. Depending on your flight times and what you’d like to do, two or three nights is likely enough at Lake Titicaca. Seeing the closer floating islands takes a half day, and the further (more beautiful) ones require a full day’s tour. There are ruins to explore as well.
Back to Lima
Once you land back in Lima, your heart rate will return to normal and the air — even that on the airport tarmac — will taste sweet and moist. Enjoy Lima, eat more ceviché now that your appetite has returned (Pescados Capitales is one of my favourite restaurants) and relax before you head back home. Or take advantage of your time in South America and visit another must visit destination, Galapàgos in Ecuador!)
What else can you do to lessen altitude sickness?
Stay hydrated: This is your best bet for feeling healthy. Drink water like it is going out of style, and you body will thank you. You will be walking a lot, which already means you need to drink more than normal. While Machu Picchu is very humid, Cuzco and Lake Titicaca are not. Not only will you want extra water there, you’ll want heavy duty skin moisturizers!
Take it easy: Walk slowly, climb stairs even more slowly. Pause to rest and enjoy the view. The effects of altitude have nothing to do with your fitness level, so if you need a rest, you’re not proving to your travel companion that you haven’t kept up with your jogging. Altitude just affects some people more than others (in fact, some studies show that younger, fitter people can have more difficulty than older, less fit types … but perhaps that is just because the young ones think they’re invincible and don’t take it slowly enough?)
Eat lightly: You body suppresses non-essential functions when it is struggling with altitude, so you’ll not digest food very well for your first couple days at any new altitude. You won’t be particularly hungry either, so pay attention to what your body is telling you. (Newly arrived in Cuzco? You’ll feel nourished but not overwhelmed with too much food at Bojosan Japanese Udon Bar).
Take oxygen: Most hotels have an oxygen tank on hand. You can sit (usually in the lobby somewhere) and breathe some highly oxygenated air for 15 minutes or so to perk up. Few hotels will charge you for this service, and most will carefully clean the mask with an alcohol wipe before giving it to you to wear. You can also buy individual bottles of oxygen at many shops and in some hotels.
Drink coca tea: every hotel in Peru will offer coca tea (free of charge) in their lobby. Many people say it helps altitude sickness (many others say it doesn’t). Sometimes you will be offered a tea bag and sometimes dried leaves which you steep in hot water. There are coca candies in many shops too. If you might be drug tested on your return home, do not ingest any coca product, as it could leave traces of the chemical found in cocaine in your urine. And no, coca tea will not make you high in any way.
Chew fresh coca leaves: At Lake Titicaca, I saw a young woman who was so weakened by altitude sickness that she had trouble standing (yes, she had come directly from Machu Picchu without acclimating in Cuzco). Our guide gave her some fresh coca leaves to chew and two minutes later she was back on her feet, smiling and walking around, and said she felt normal. The effects lasted about 45 minutes. Placebo? I don’t know, but if you need a short term fix, you could try it.
Drugs: Despite the advertising, you should not need to take medication if you are just taking a day trip to Machu Picchu. Diamox (acetazolamide) is the most used drug to treat altitude sickness, but it is not as effective as acclimating at a sensible pace. If you’ve had to cut your acclaiming time short, Diamox will help in Cuzco and Lake Titicaca, and on the Inca Trail.