ALTITUDE SICKNESS IN PERU: THE GUIDE YOU WISH YOU’D READ BEFORE ARRIVING

I’ll be honest from the start: soroche (altitude sickness) is real, annoying, and it can ruin your first travel days if you don’t take it seriously. But it’s not the monster some make it out to be. After 20 years taking travelers into the high Andes, I’ve seen everything—from people jogging from the airport without issues to Olympic athletes vomiting in their hotel rooms.

The good news: altitude sickness is completely manageable if you know what to do. And that’s exactly what I’ll teach you here.

What Is Soroche and Why Should You Care?

Soroche is the Quechua word for altitude sickness, and in Peru you’ll hear it a thousand times. In simple terms, it’s what happens when your body ascends too quickly to a place where there’s less oxygen per breath.

Think of it like this: at sea level (Lima), each breath gives you a certain amount of oxygen. When you arrive in Cusco (3,400 m / 11,150 ft), each breath gives you roughly 60% of that oxygen. Your body flips into “what’s going on?” mode and starts adjusting. Those adjustments feel like symptoms.

It’s not about atmospheric pressure alone, it’s not that the air is “thinner” in a casual sense, and it’s not that oxygen “ran out.” There are simply fewer oxygen molecules per cubic meter of air. Your body needs time to adapt.

Important: It has nothing to do with your fitness level. I’ve seen marathon runners suffer badly while a 70-year-old grandmother who never exercises feels fine. Soroche doesn’t discriminate—it’s part genetic lottery, part how fast you ascended.

Altitudes You Should Know (and Respect)

Sea Level – 2,500 m: Generally no problem

• Lima: 154 m
• Paracas: 0 m
• Máncora: 0 m

2,500 – 3,500 m: Here’s where it starts

• Arequipa: 2,335 m (some feel it lightly)
• Chachapoyas: 2,335 m
• Huaraz: 3,052 m (many feel it)
• Cusco: 3,399 m (most feel something)

3,500 – 4,500 m: Higher risk of moderate soroche

• Puno: 3,827 m (this one hits hard)
• Juliaca: 3,825 m
• La Paz (Bolivia): 3,640 m

Above 4,500 m: Serious altitude

• Abra Málaga (on the way to Machu Picchu): 4,316 m
• La Raya Pass (Cusco–Puno): 4,335 m
• Vinicunca / Rainbow Mountain: 5,200 m at the top
• Huascarán (alpinism): 6,768 m

General rule: Above 2,500 m, your body notices. Above 3,500 m, take it seriously.

Symptoms: How to Tell It’s Hitting You

Mild Symptoms (Most Common)

• Headache: like a tight band around the head—persistent and annoying
• Extreme fatigue: three steps feel like a marathon
• Shortness of breath (especially when walking)
• Interrupted sleep: waking up at night feeling air-hungry (very common)
• Mild nausea
• Loss of appetite (even in the land of world-class cuisine!)
• Dizziness, especially when standing up quickly

What to do: This is normal and will pass. Give yourself 24–48 hours and take it easy.

Moderate Symptoms (You Need to Act)

If mild symptoms don’t improve after day one, or if these appear:

• Headache that doesn’t go away with ibuprofen
• Vomiting (not just nausea)
• Persistent dizziness
• Mental confusion or trouble thinking clearly
• Loss of coordination (stumbling, struggling with simple tasks)
• Can’t sleep at all due to breathlessness

What to do: Descend if possible, or use supplemental oxygen. Ask your hotel—most in Cusco and Puno have oxygen. If you don’t improve within a few hours, go to a clinic.

Severe Symptoms (EMERGENCY — Go Now)

Rare, but serious:

• Pulmonary edema: cough with pink/foamy sputum, bubbling sounds when breathing, severe breathlessness even at rest
• Cerebral edema: severe confusion, major loss of coordination (can’t walk straight), hallucinations, loss of consciousness

What to do: Hospital immediately. The only real cure is to descend fast while receiving treatment.

Acclimatization Plan: Day by Day (What Actually Works)

The key to avoiding soroche is a gradual ascent. But I know your vacation days are limited and flights are set. Here’s a realistic plan:

If You Arrive Directly in Cusco from Sea Level (Most Common)

DAY 0 — Flight to Cusco

• You land. You’re already at 3,400 m.
• Don’t: start touring at speed, run up stairs, or carry heavy bags.
• Do: walk slowly, let the hotel porter carry luggage, take a taxi (don’t walk 20 blocks with a backpack).

DAY 1 — First Day in Cusco (Critical)
Morning:

• Expect a bit of heaviness and fatigue—normal.
• Eat a light breakfast.
• Have a coca tea first thing (it helps).
• Stroll the historic center slowly—think leisurely, not rushed.

Afternoon:

• If you feel okay, do a gentle city tour. Don’t hike up to Sacsayhuamán on foot.
• If you feel off, rest at the hotel. That’s smart, not lazy.
• Keep meals light—soups are perfect.

Evening:

• Early, light dinner.
• No alcohol. Seriously—not even one beer (it dehydrates and worsens symptoms).
• Early to bed. If you sleep poorly, that’s normal the first night.

DAY 2 — Second Day in Cusco

• You should feel better. If not, keep it easy.
• Do the Sacred Valley (lower altitude: Ollantaytambo 2,800 m, Pisac 2,970 m)—descending helps.
• Museums, markets, gentle walking.
• Keep coca tea, light meals, and still no alcohol.

DAY 3 — Third Day

• You should be largely adapted.
• Higher-effort activities are fine.
• If you’re starting a trek, this is a good day to begin.
• Eat normally.
• A beer is okay—moderation.

Ideal Plan (If You Control Your Itinerary)

Option A (Classic Stair-Step):

1. Lima (0 m) — 2–3 days
2. Arequipa (2,335 m) — 2 days
3. Puno (3,827 m) — 2 days
4. Cusco (3,399 m) — You’ll be well adapted

Option B (Cusco + Valley):

1. Lima (0 m) — 1–2 days
2. Cusco (3,399 m) — Arrive, then immediately descend to Sacred Valley
3. Sacred Valley (≈2,800 m) — 2 days
4. Return to Cusco adapted
5. Machu Picchu (2,430 m) — No problem

Option C (Express but Effective):

1. Arrive in Cusco in the morning
2. Go straight to Ollantaytambo/Urubamba (Sacred Valley, lower)
3. Sleep 1–2 nights there
4. Return to Cusco partially adapted

What To Do If You Get Soroche (Real Fixes)

Immediate Steps:

1. Rest — This is not the time to be a hero.
2. Hydrate — Constantly. Clear urine = well hydrated.
3. Coca tea — Yes, it helps (oxygenation and headache). 2–3 cups/day.
4. Oxygen — Most hotels in Cusco/Puno have it. 15–20 minutes can reset you.
5. Ibuprofen or acetaminophen — For headache (normal dose).
6. Light food — Soups and simple carbs; avoid greasy/heavy meals.
7. Breathe deeply — Slow inhales and exhales genuinely help.

Medications:

• Sorojchi Pills (OTC in Peru):
  • Combo of analgesics + caffeine
  • Helps with headache and fatigue
  • Follow label directions
  • Not a magic cure, but good relief
• Acetazolamide / Diamox (prescription):
  • The “official” preventive for altitude sickness
  • Speeds acclimatization
  • Start 24 hours before ascent, continue 2–3 days
  • Side effects: frequent urination, tingling in fingers, metallic taste
  • Some swear by it; others dislike the side effects
  • Consult your doctor before travel if altitude worries you
• Viagra / Sildenafil (yes, really):
  • Some mountaineers use it for vasodilation and better oxygenation
  • Has side effects and contraindications
  • Not recommended without medical supervision

What NOT to Do (Mistakes I See All the Time)

❌ Do NOT Drink Alcohol in the First 48 Hours
Alcohol severely dehydrates you, interferes with oxygenation, and makes you sleep worse. It’s literally the worst thing you can do. I know the hotel may offer you a welcome pisco sour—say no.
After 2–3 days, once you’re adapted, enjoy all the pisco you want.

❌ Do NOT Eat Heavy Food on Day One
Your stomach is affected by altitude too. Greasy or heavy food will sit like a rock. Save the cuy and chicharrón for when you’re acclimatized.

❌ Do NOT Do Intense Exercise
I once saw someone arrive in Cusco and go for a run. He ended up vomiting on the street. Don’t be that person.
For the first days: walk gently, nothing more. Hardcore hikes can wait.

❌ Do NOT Ignore Symptoms
If you feel unwell, it’s not weakness—it’s physiology. Your body is telling you something. Listen to it.
I’ve seen people ruin entire trips by refusing to take a rest day when they needed it.

❌ Do NOT Stay in Bed All Day
This may sound at odds with “rest,” but here’s the point: you need light movement. Staying in bed 24 hours worsens acclimatization. Walk slowly, move, but don’t overexert.

Local Remedies: What Works and What’s a Myth

✅ WORKS: Coca Tea (Mate de Coca)
Not a myth. Coca leaves contain alkaloids that help oxygen uptake and relieve headache and nausea. Every hotel in Cusco offers coca tea free in the lobby.
How to drink it: 2–3 leaves in hot water, steep 5 minutes. Have 3–4 cups a day.
Note: No, it won’t get you high. It’s not cocaine. It’s fully legal in Peru. And yes, it works.

✅ HELPS: Chewing Coca (Chacchar)
Locals chew coca leaves directly, with a bit of lime (llicta) to activate the alkaloids. It’s more effective than tea, but tastes bitter and numbs the mouth. If you try it, ask a local how to do it properly.

⚠️ UNCERTAIN: Raw Garlic
Some say chewing raw garlic helps. There’s little scientific evidence, but it likely won’t hurt (other than your breath). Try it if you want.

⚠️ UNCERTAIN: Muña (Andean Herb)
Another herb often recommended as a tea. It has digestive properties and may ease nausea. Does it help with altitude specifically? Unclear—but it won’t harm you.

❌ MYTH: Drinking More Water Prevents Soroche
Being hydrated helps with symptoms, but it doesn’t prevent altitude sickness. You can still get it; hydration mainly lessens the headache.

❌ MYTH: If You’re Fit, You Won’t Get It
Repeating because many don’t believe it until it happens: fitness doesn’t matter. I’ve seen athletes suffer and sedentary people do fine.

❌ MYTH: Constant Bottled Oxygen Prevents Soroche
Breathing oxygen makes you feel better temporarily, but it doesn’t speed acclimatization. Your body needs time to adapt to lower oxygen.

Who’s at Higher Risk

While it’s unpredictable, some groups are more likely to suffer severe soroche:

Higher Risk:
• People who have previously had severe altitude sickness
• Those who ascend very quickly (plane straight from sea level)
• People with preexisting heart or lung conditions
• Those who usually live at sea level (if you live in La Paz, you won’t struggle in Cusco)
• Under 50 years old (it sounds odd, but statistically younger travelers suffer more)

Lower Risk:
• People already adapted to moderate altitude
• Those who ascend gradually
• Older adults (counterintuitive, but stats show it)

Special Cases:
Pregnant women: Consult your doctor beforehand. Generally, above ~3,500 m is not advised.
Children: They can get soroche just like adults, but sometimes don’t express symptoms clearly. Watch for unusual fatigue or irritability.
People with anemia: Soroche can be worse. Make sure your iron levels are good before traveling.

When to See a Doctor (Don’t Be a Hero)

Go to a clinic or doctor if:
• Symptoms worsen after 24–48 hours instead of improving
• Severe headache that doesn’t respond to medication
• Constant vomiting that prevents you from keeping fluids down
• Mental confusion, trouble speaking or thinking
• Severe shortness of breath, even at rest
• Cough with liquid or foam (sign of pulmonary edema)
• You can’t walk in a straight line (sign of cerebral edema)
• Blue lips or nails

There are clinics in Cusco and other tourist cities that treat soroche routinely. Don’t be embarrassed—use them.
Typical treatment: oxygen, IV fluids, medication. You’ll often feel better in hours. If it’s severe, they’ll move you to a lower altitude.

Tips from Real-World Experience (20 Years of Watching This)

1. Coca tea is your friend. Not a joke. Have a few cups a day. It’s everywhere, tastes good, and really helps.
2. The first two days are the worst. Hang in there. It gets better. Don’t judge your whole trip by Day 1.
3. The Sacred Valley is your salvation. If you feel bad in Cusco, drop to the Sacred Valley (Ollantaytambo, Urubamba). Being 500–600 m lower makes a big
4. Not everyone in your group will feel the same. Your partner may be bouncing while you feel awful. It’s normal—and not your fault.
5. Machu Picchu is lower than Cusco. Good news: at 2,430 m, most people feel much better there.
6. Returning to altitude is easier. If you drop to Lima for a few days and come back, your body “remembers” and adapts faster.
7. The foodie splurge can wait. Peru’s cuisine is amazing, but keep it simple at first. You’ll have time to feast once adapted.
8. Weather can help or hinder. Extreme cold, rain, and humidity make symptoms worse. If you can, arrive in dry season (May–September) when daytime warmth helps.
9. Sleep feels weird. You may wake up repeatedly, gasping lightly. Your brain is adjusting your breathing. Breathe deeply and go back to sleep.
10. Don’t cancel because of fear. With proper prep, the vast majority manage soroche fine. Don’t let fear stop you.

Prevention Plan: Start Before You Travel

2 Weeks Before:
• If you have anemia, address it (iron-rich foods, supplements if your doctor recommends)
• Stay generally well hydrated
• If you smoke, try to cut down (it helps)

3–5 Days Before:
• If using Diamox/Acetazolamide, start 24–48 hours before ascent
• Get good sleep

Flight Day:
• Hydrate a lot during the flight
• Avoid alcohol on the plane
• Sleep if you can
• Eat light

Upon Landing:
• Walk slowly
• Drink water
• Ask for coca tea
• Rest

The Truth About Soroche No One Tells You

After two decades watching travelers arrive at altitude in Peru, here are a few uncomfortable truths:

1. It’s unpredictable. You can’t control it completely. Do everything “right” and still feel bad, or everything “wrong” and be fine. Genetics + luck.
2. It will limit your first days. Accept that you won’t be at 100% for 1–2 days. Plan relaxed itineraries at the start.
3. It’s not an excuse not to come. 99% of people adapt without serious problems. Severe cases are rare.
4. Your mindset matters. Panic makes it worse. Relax, breathe—it will pass.
5. It’s absolutely worth it. Yes, it’s annoying at first. But Machu Picchu, the Sacred Valley, Lake Titicaca—every minute is worth it.

Summary: What You Really Need to Remember

If you only keep 10 things from this guide, make them these:

1. ✅ Ascend slowly if you can. Gradual is better.
2. ✅ Take it easy the first 2 days. That’s smart, not lazy.
3. ✅ Coca tea works. Drink several cups a day.
4. ✅ Hydrate constantly. Water, water, water.
5. ✅ Eat light at the start. Soups, simple carbs.
6. ✅ Zero alcohol for the first 48 hours. After that, fine.
7. ✅ Mild symptoms are normal. They improve with time.
8. ✅ The Sacred Valley is lower. Go down if you feel bad.
9. ✅ Ask for oxygen without hesitation. Hotels have it.
10. ✅ See a doctor if you get worse. Don’t play the hero.

One Last Thing

I’ve seen thousands arrive in Cusco worried sick about soroche. Most are surprised it wasn’t nearly as bad as they feared. Some don’t feel it at all.
Altitude sickness is real, but it’s not the end of the world. With the right precautions and realistic expectations, you’ll be fine.

And when you’re standing before Machu Picchu, or sailing Lake Titicaca, or walking Cusco’s streets at 6 a.m. with the sun on the peaks, I promise any discomfort will feel like nothing.

Peru is waiting. Altitude is just a small hurdle at the start of an unforgettable adventure.
Ready for your trip? Breathe deeply (literally), sip your coca tea, and enjoy.

Do you have more questions about soroche or your trip to Peru? Contact us. We’ve spent 20 years helping travelers conquer the Andean heights.