When is adaptation complete on ascent to high altitude ?Gustavo Zubieta-Calleja (Jr)Gustavo Zubieta-CastilloHigh Altitude Pathology InstituteClinica IPPALa Paz Boliviawww.altitudeclinic.com

The definition of adaptation to high altitudeThe organic systems of human beings and all other species tend to adapt to any environmental change and circumstance, and never tend towards regression which would inevitably lead to death. Gustavo Zubieta-Castillo Sr.

The High Altitude Adaptation FormulaAdaptation to high altitude = timealtitudeFor a fixed altitude, the only significant variable is time.How long does it take to achieve full adaptation to a fixed altitude ?

The Mechanisms of Adaptation to high altitudeMacro-systemicRespiratory Increased VentilationCardiacIncreased Heart RatePulmonary HypertensionMicro-systemicBlood oxygen transportHematocrit increaseIncreased circulationNeoangiogenesisCellular changesIncreased mitochondrial densitySodium and Potassium pump changesHydro-balance Neuro-endocrine changespH correction

The Mechanisms of Adaptation to high altitudeHypoxia induced gene expressionRelevant target genesErythropoyetinVascular endothelial growth factor (VEGF)Tyrosine hydroxylaseEndothelin 1Genes involved in glucose metabolismNitric Oxide synthase

Transcription factorsHypoxia inducible factor-1 (HIF-1)Activator protein-1 (AP-1)Nuclear factor-IL6 (NF-IL6)Early growth factor (Egf-1)Nuclear factor kappa B (NFkB)

The adaptation to sustained exerciseTime dependantToo acute lesion

QVHbHRVSRRVT..STROKE VOL.HEART RATERESP. RATETIDAL VOL.

AMSFullAdaptationIntermediate AdaptationCMSSubacute Mountain SicknessAcute Adaptation

Grfico1

36

40

41.5

45

48

48.7

50.2716216369

Ht in %

Days

Ht in %

Hematocrit increase on return from sea level to high altitude 3510 m

Hoja1

Resultados del hematocrito luego del retorno de Dinamarka donde estuve 3 meses.

Mi hematocrito normal en la altura es de 50 %

DateHt in %DaysHt in %

25-Sep36136

27-Sep40340

28-Sep41441.5

2-Oct45845

16-Oct482248

24-Oct48.73048.7

4050.2716216369

Hoja1

0

0

0

0

0

0

Ht in %

date

Ht in %

Ht increase on return to high altitude 3510 m.1 month

Hoja2

0

0

0

0

0

0

0

Ht in %

Days

Ht in %

Hematocrit increase on return from sea level to high altitude 3510 m

Hoja3

0

0

0

0

0

0

Days

Adaptation and DivingAdaptation to diving = timealtitude depth

ConclusionsImmediate adaptation to high altitude is possible but is not optimal nor definitive.

The optimal adaptation is achieved only when the hematocritreaches the plateau value.

This value is specific for each altitude and for each individual.

The time lapse depends on the initial hematocrit upon ascent and on the health status.