Buddha Basnyat: High altitude illness
High altitude illness can be prevented by a simple rule: don't go too high, too fast. Drugs can also be used, and Dr Basnyat showed that a much lower dose of Diamox, a commonly used drug, is as effective. His research also focusses on the effect of high altitude on pilgrims, an older, poorer and more vulnerable population.
This is a podcast from the Nuffield Department of Medicine. Today we speak with Dr Buddha Basnyat about his research on high altitude illness.
Q: What is altitude illness?
Buddha Basnyat: Altitude illness is like a hangover that starts at about 2,500 metres or 10,000 feet. It is a headache and nausea. These are the first signs of acute mountain sickness and they can be life threatening. They can go on to cause cerebral oedema and pulmonary oedema, which is water in the lungs and water in the head. It can be life threatening.
Q: How can you minimise your chances of suffering from altitude illness?
BB: By making sure you are aware of this disease entity, and once you are aware you will not go up too high too fast. The suggestion is that after 10,000 feet or 3,000 metres, the present night’s altitude should not be more than 400 or 500 metres more than the previous night. You should not increase by more than 400 or 500 metres so that your body has time to acclimatise. Going up slowly, in other words. Taking your time and not going up too high too fast. That is the main issue here.
Q: How can we increase awareness of altitude illness?
BB: There is not enough awareness about this. For instance, very recently in Mount Kilimanjaro which is a standalone mountain in Kenya, there was a tragedy. A racing car driver, Mr Zulu from South Africa, went on a five-day trip to Kilimanjaro, going up too high too fast, and he died. It was very tragic. However, from the tragedy, I hope that people will learn that they should go up slowly, this is important. In the Himalayas there is much more awareness about altitude illness and I think the focus now needs to be on this mountain Kilimanjaro which is politically incorrect but I think it is Killer Kili. Awareness needs to be generated and maybe taking advantage of this tragedy but to good effect to help other people.
Q: What are the most important lines of research which have developed over the last 5-10years?
BB: Probably the most important line of research that has developed is in the field of genetics. Professor Sir Peter Ratcliffe from the Nuffield Department of Medicine is involved, through the discovery of a protein called HIF, hypoxia-inducible factor protein. If you have an over-representation of this protein, you are better able to adapt to high altitude. This is why Tibetans it seems have an over-representation of this protein and they are able to adapt better. This HIF protein, this factor, is important. It seems it is a master switch that impacts on cardiovascular problems, cancer problems. It is a bigger deal than high altitude hypoxia.
Q: Why does your research matter and why should we fund it?
BB: People live at high altitude and travel to high altitude. Populations in South American Altiplano, in the Tibetan plateau, there are thousands and thousands of people that live there. We have restricted our discussion so far to acute mountain sickness, but there is something called chronic mountain sickness which people living at high altitude can suffer from. It is an important area and people travel up to high altitude, millions go up to high altitude. Obviously there is a lot of human movement so it is very important area which does not get enough emphasis.
Q: How does your research fit in to translation medicine within the department?
BB: In terms of translational medicine, we have studied a drug which prevents altitude sickness. It is very well known and is called Diamox. A big dose of Diamox was suggested prior to our studies: they suggested 750mg. There was big study that came out in the BMJ (British Medical Journal) around 2000. We said we did not think this was right, we have anecdotal evidence of a most lower doses working. We clearly showed that a lower dose causes less side effects, 250mg maybe even less is what our data was showing. Rather than giving this huge, hefty dose of 750mg for the prevention of acute mountain sickness, you can get by with a lowly 250mg. That is one area where we have been helpful.
We have started focusing on another very important area. You think of thousands of tourists going up to high altitude, but millions of pilgrims with what is called co-morbidities, diabetes or others, and they are not your trekkers and climbers but are people who want to go to the sacred sites that are at very high altitudes. For example there is a sacred lake in South Asia, there are many lakes like this and pilgrims go up. They make a pilgrimage. Millions of them go up as opposed to thousands of tourists. We need to focus on keeping the tourists safe, but we also need to keep the pilgrims safe. They are older, poorer and more vulnerable. We are focusing attention on this.
This interview was recorded in September 2016