Nancy Hansen (r.) and Ralf Dujmovits at the DLR

“We were the mice for five weeks,” says Nancy Hansen describing the time she and Ralf Dujmovits – as reported – spent in a hypoxia chamber at the German Aerospace Center (DLR) in Cologne half a year ago. The goal of the study was to find out whether, under certain circumstances, extreme hypoxia can lead to a strengthening of the heart in humans – as previously found out in two experiments with mice in the USA. After an acclimatization phase of around two weeks, the climbers had spent 16 days at a simulated altitude of 6,700 meters or higher, including four days at an oxygen content of only eight percent, which corresponds to 7,112 meters. “I suffered quite a lot,” admits Nancy. “But it was a big privilege to be part of the study.” Ralf is also still impressed by the experience: “I was hard on the edge. To be honest, I wouldn’t do it again. I underestimated the whole thing.” Last week the couple was in Cologne again – for one of several follow-up examinations. The first preliminary results of the study are now available.

Only 56 percent oxygen saturation

Pulmonary function test on the climbing wall

Extreme hypoxia initially had different effects on the bodies of Nancy and Ralf. Ralf, due to his many expeditions to eight-thousanders apparently better accustomed to the lack of oxygen, acclimatized much easier than Nancy. “One of the DLR doctors told me: ‘I hope you feel better than you look’,” she remembers and smiles. Once, the 50-year-old Canadian had an oxygen saturation of only 56 percent, a hospital patient would have been a case for intensive care. A DLR team was on duty around the clock for the two climbers. The scientists took blood and urine samples, carried out ultrasound and MRI examinations or cognitive tests. The analysis of the huge amount of data from the various tests is far from complete.

Both climbers lost muscle mass, they slept worse. It was astonishing that Nancy’s and Ralf’s responsiveness and concentration ability remained almost constant, even under extreme hypoxia. “However with the restriction that they were really challenged by the cognitive tests and had to concentrate,” says Dr. Ulrich Limper, who led the DLR study together with Prof. Jens Tank. During normal conversation, some “dropouts” were noticed.

Kidney performance also declined

Leaving the hypoxia chamber after five weeks

In Nancy’s heart, the right ventricle swelled and the pumping capacity decreased. In her brain, minor so called “White Matter Lesions” occured, which are frequently found in elderly people. In Ralf’s brain, the veins swelled over time without the 57-year-old suffering from severe headaches. In addition, the kidneys of both climbers worked much worse under hypoxia – albeit still sufficiently. “The good news is that all symptoms disappeared within 30 hours after Nancy and Ralf had left the hypoxia chamber and breathed normal air again,” says Dr. Fabian Hofmann, one of the DLR doctors.

It is not yet possible to say whether a damaged human heart is positively influenced by extreme hypoxia, as found out in the mice experiment. “We were dealing here with two healthy hearts of top athletes,” says Hofmann. “But it’s amazing what we can do to the hearth without structural change.” Further studies are to follow, if possible also with heart patients.

P.S.: Nancy and Ralf are about to set off for an expedition to Antarctica – to significantly lower altitudes than simulated at the DLR.

With Nancy Hansen (r.) and Ralf Dujmovits in the DLR hypoxia chamber

And suddenly the call came from space: “Here is Alex”. At first Ralf Dujmovits did not know who was talking at the other end of the telephone line: “Alex? Then I suddenly recognized the voice I had heard two days earlier during the broadcast of the rocket launch.” Alexander Gerst inquired from the International Space Station (ISS) about the condition of the German climber and his Canadian partner Nancy Hansen in the hypoxia chamber of the German Aerospace Center (DLR) in Cologne. “It sounded like he was sitting next door.” For a quarter of an hour, Ralf, the first and so far only German climber to have scaled all 14 eight-thousanders, spoke to “Astro Alex”, the first German astronaut to take command of the ISS. “He was very interested in our experience in the lab. That was great.” Of course, Nancy talked to Gerst too. For both climbers it was a “real highlight”, says the 49-year-old Canadian.

Underestimated strain

Alexander Gerst watching World Cup football at the ISS

After five weeks in the 110 square meter hypoxia chamber, the door will open for Dujmovits and Hansen on Tuesday. Then the experiment will be over, in which it should be tested whether heart functions improve during a long stay in extremely thin air. Ralf and Nancy spent the last two weeks all day at a simulated altitude of 6.718 meters and slept at night at 6,490 meters. That left its mark. “You see us quite tired here,” says Ralf, when I visit them (with bottled oxygen) again last weekend. “I had expected otherwise. I was convinced that we would be a little tired at first, but after a while we would get so accustomed to the low-oxygen conditions that we would be able to cope well with it. I underestimated how exhausting the whole thing is.”

“A huge success”

One reason for this fatigue may be that – as it turned out with Ralf’s MRI – the blood in the veins of the brain has become extremely congested over time and the veins are swollen now. “I’ve never seen it so massive. At first glance, you’re not happy about this,” says Dr. Ulrich Limper, who leads the DLR study together with Prof. Jens Tank. “On the other hand, it is not a direct threat. We assume it will regress.” In four weeks, Dujmovits and Hansen will return to DLR for their first follow-up examination.

The scientists have collected a great deal of data that will now be evaluated. First results are expected to be available within six months. “It’s already a huge success for us,” says Limper. “The concept worked, we learned a lot. We are still cautious, but clinically it looks as if our hypothesis that certain heart functions improve under the influence of hypoxia could be confirmed. If we can substantiate that with the data, it would be great.” The study might even lead to new therapies for heart attack patients.

“Swollen” heart

Nancy on the mobile climbing wall

Originally, it had been planned that, after an acclimatization phase, the two climbers would live day and night at a simulated altitude of 7,112 metres for two weeks. But the scientists had to change their arrangements. At that simulated height, Nancy’s pulmonary artery pressure – the pressure with which the oxygen-poor blood is pressed from the heart into the lungs – was significantly increased. The right half of her heart was therefore, to put it simply, “swollen”, Nancy’s values were at the limit. “From our point of view it would not have been successful to ‘chase’ her up”, says Limper. “Her condition probably would have gotten worse.” Therefore the simulated altitude was lowered to below 7,000 meters, at night even further down than during the day. “Nancy’s body coped with this. Her values slowly improved and towards the end approached those of Ralf again.”

Not much higher than 7,000 meters

Does the body learn from frequent stays at high altitude?

According to Limper, it is assumed that in Nancy’s case it was a “normal reaction of a heart that is simply not yet accustomed to very high altitudes”. Ralf also told about health problems during his first expeditions, which no longer occured during his later projects. “There may be something like a long-term adaptation,” says the physician, adding that this has not yet been scientifically proven.

Nancy’s troubles made her and Ralf think. “It shouldn’t be a problem to tackle a seven-thousander where we spend the last night at 6,300 or 6,500 meters,” says Ralf. “But above that altitude, Nancy could suffer some damage to health. That’s what we’ve learned, and we’ll take that into account, of course.”

Constantly felt cold

Less muscular mass

During the time in the hypoxia chamber, both climbers have lost more than two kilograms of body weight each, primarily muscle mass. “The upper arms have become thinner,” says Ralfs, “and where normally the trousers are taut on the thighs, now everything flaps.” The climbers’ weight loss was lower than expected, says Ulrich Limper. “We attribute it to the fact that apart from hypoxia they had no stress factors as usual in the mountains: no cold, no pitching up the tent, no continuous physical strain. In the end, they moved very little.” Nancy and Ralf tried to stay reasonably fit on a treadmill, an ergometer and a mobile climbing wall. One of the surprising findings for the scientists was that Ralf was exhausted after 50 minutes on the ergometer, but did not sweat at all. It also seemed unusual that despite a room temperature of 24 degrees Celsius Nancy and Ralf felt so cold that they pulled two jackets over their T-shirts. So there are still a few question marks.

Into the sun!

“It was worth the effort”

Nancy and Ralf do not regret getting involved in the DLR experiment. On the contrary. “I would do it again,” says Nancy. “Scientifically I found the whole thing incredibly interesting. Of course, not every moment was fun, but overall it was an amazing experience that was pretty unique.” Also for Ralf “it was absolutely worth the effort”: “We leave the project healthy. And if we can make a contribution to the future development of a therapy for heart attack patients, then everything is perfect.”

And what are they looking forward to the most? “Sunshine,” Nancy answers quick like a shot. Ralf especially longs to see his family and friends again and is looking forward to sitting in the garden, running through the woods or cycling on his mountain bike for hours: “We had an incredibly committed team of scientists and doctors around us. We enjoyed it, it was exciting, and we learned a lot. But now it’s good that we’re coming home.”

Visiting Ralf Dujmovits (r.) with mask

Bottled oxygen on a mountain has always been out of the question for me. On principle. Today I made an exception – for a “virtual mountain”. To be able to visit Ralf Dujmovits, the only German mountaineer who has scaled all 14 eight-thousanders, and his partner, the Canadian climber Nancy Hansen, it is mandatory to use a breathing mask. After two weeks in the hypoxia chamber of the German Aerospace Center (DLR) in Cologne, the two test persons have reached the simulated target altitude of 7,112 meters. The percentage of oxygen in the air, normally 21 percent, was gradually reduced to eight percent by adding nitrogen. “It’s like climbing a mountain. The acclimatization is almost done, now we’re heading for the summit,” says Ralf. “The time on the summit will be of course much longer.”

Short rest, then things gets serious

Nancy Hansen’s blood pressure is checked

In the coming days, Ralf and Nancy can once again briefly “descend” to breathe thicker air. On 4 June, however, the crucial phase of the study will begin, during which the two climbers are to stay constantly at a simulated altitude of 7,112 metres for two weeks. The aim is to test whether extreme hypoxia can strengthen the heart and even lead to the formation of new cells. If this finding from experiments with mice can be confirmed in humans, completely new therapeutic approaches would be conceivable for heart attack patients.

How much physical deterioration will there be?

Eight percent oxygen content

“We are both excited,” reveals Nancy. “I think the first few days will be okay. And then either it will feel normal or we start to deteriorate. Nobody really knows.“ Ralf recalls the French climber Nicolas Jaeger, who in 1979 in a self experiment spent two months alone in the summit area of the 6,768-metre-high Huascaran in Peru: “Cognitively he felt not so bad. In the end, physical deterioration became the major problem for him. I expect the same from us. We’re probably going to lose a lot of muscle.”

Breathe properly

So far, Hansen and Dujmovits have coped well with the low-oxygen time in the DLR’s hypoxia chamber. In any case, you can’t see yet what a burden they’re under. “I had three, four pretty bad headaches, mostly in the night,” says Nancy. “But it has gotten better.”  The 49-year-old Canadian finds it fascinating to see “what’s happening inside of our bodies, also in comparison between Ralf and I”. Her partner acclimatizes much better than her, says Nancy: “The way his lungs exchange oxygen with his heart is very different to my exchange. Ralf is teaching me how to breathe properly in here.”

Currently no climbing wall training

Pulmonary function test on the climbing wall

Dujmovits estimates that he has now lost “40 to 45 percent performance”. Dosed endurance training on the bicycle ergometer or the treadmill is still possible at the current simulated altitude of around 7,000 meters, says the 56-year-old. However, the two are currently stay well clear of the mobile climbing wall in the hypoxia chamber. “The strain on the muscles is much greater, and we get very quickly into the anaerobic phase. But we want to avoid an oxygen defiency that would cause immediately headaches,” says Ralf.

No cabin fever

I ask whether the relationship of the two test persons is put to a serious test by the long time in the hypoxia chamber? “Not so far,” Nancy replies, laughing. “We spend so much time together. There are no problems at all, and I don’t expect any.” Ralf nods. “I think it’s important to keep stress out of a relationship. We’ve done quite well so far.”

No Big Brother

Nancy and Ralf in the DLR hypoxia chamber

Even the constant camera surveillance doesn’t bother them anymore. “We’re not making  ‘Big Brother’ here,” says Dujmovits. “We know that the scientists are trustworthy with everything that can be seen here.” Meanwhile they almost ignore the cameras’ existence. “This morning I was just walking around the rooms in my underpants. Only on my way back I realized that everyone in the surveillance room could see me like this.” Ralf emphasizes that the whole experiment is “a team effort”. The climber specifically praises the committed DLR scientists: “They are here for us 24 hours a day in an all-round shift work.”  Nancy is also enthusiastic about the team. “All the staff here have been treating us so well. We feel really like a prince and a princess.”

Ralf Dujmovits and Nancy Hansen

The doors have closed behind Ralf Dujmovits and Nancy Hansen. The so far only German climber who has scaled all 14 eight-thousanders and his Canadian partner moved in a 110-square-meter hypoxia chamber of the German Aerospace Center (DLR) in Cologne on Tuesday. As reported, the two mountaineers are participating in a study conducted by DLR in cooperation with the University of Texas to investigate whether extreme hypoxia can also have a positive side effect for human beings. US researchers from Texas found in two experiments with mice that heart muscle cells devided when the animals were exposed for two weeks to oxygen deficiency corresponding to conditions at 7,000 m. In mice which had previously been triggered myocardial infarctions, cardiac function improved after two weeks of hypoxia.

Medical control around the clock

Monitor in the control room

Ralf and Nancy, both healthy, are the subjects of the pilot study. They are to stay in the hypoxia chamber for about a month. In the first few weeks, acclimatization as on a Himalayan expedition is simulated. The oxygen percentage in the air will be gradually lowered and temporarily increased only twice in between – as if the two climbers would descend again to breathe thicker air. The last two weeks, the 56-year-old German and the 49-year-old Canadian are to  spend in a simulated height of 7,000 meters. The experiment can be stopped at any time in case serious problems arise. A DLR research team monitors Dujmovits’ and Hansen’s state of health around the clock. The daily schedule includes heart and lung function checks, blood and urine tests, fitness checks and so-called “cognition tests”, which check the reaction and perception of the subjects.

Yesterday, I visited the two climbers in their new “home”. That was possible on Wednesday for the last time without breathing mask. After more than half hour in a simulated altitude of about 3,700 meters, I felt a little bit dizzy. I preferred to do the interview with Ralf subsequently in thick air, by phone.

Ralf, you can not get out, there is no daylight, and the oxygen is lowered. That does not sound like a holiday apartment.

Nancy has a pulmonary function test

No, it isn’t a holiday apartment. But we have adjusted ourselves to it over a long period of time. We took it that way. We prepared ourselves mentally for almost nine months. Now we are here and actually feel quite well.

How does the prospect feel of being locked up for weeks and not being able to move to fresh air? That must be almost like torture for a climber.

Not even like that. I have the great privilege that I was allowed to be outside a lot. I do not see a big problem with being inside for five weeks now. We have been asked this frequently. But neither Nancy nor I are very worried that we can not handle it. We both can be very focused on special things. We have agreed to it and accept it as it is.

How did you prepare for this experiment? Have you filled up as much fresh air and nature as possible?

Skiing down to Monte Rosa Hut

We were in Valais for a week. We spent the final two nights on the Gnifetti Hut at 3,700 meters, followed by a night in the winter room of the Capanna Margherita on the Signalkuppe at 4,550 meters. So to say, we had pure nature for us. We were completely alone on the Capanna Margherita for 24 hours. We got up at 6.30 a.m. to enjoy the beautiful sunrise. Then we skied down to the Monte Rosa Hut through best powder snow. We really filled up, had a great time and, of course, a bit of pre-acclimatization too.

What motivates you to participate in this study?

Nancy had in her family environment some cases of heart attacks that ended either deadly or in very difficult recovery. Therefore, motivation for her is really to be able to bring something forward in the field of research. It’s similar with me. My interest in medicine has always been there and will continue. Being able to be possibly part of a new treatment for heart attack patients is a great story.

Maybe it’s also an additional motivation that this “seven-thousander”, which you want to scale, is still unclimbed.

Of course, it’s a bit of a first ascent. (laughs) But it’s not so much this first-time act that motivates us, but rather the support to get a step further in heart attack research.

Nitrogen tank in the DLR outdoor area

Are you also worried, be it mental or physical, when you consider the weeks in the hypoxia chamber?

There was a big unknown we both had a hard time with. It is not so easy to convert the percentage of oxygen in the air to (virtual) altitude. We have to rely on what Jens and Uli (Prof. Jens Tank and Dr. Ulrich Limper from DLR, the heads of the study) had predicted. But here we also have the opportunity to see how the air is composed by means of sensors installed in all rooms. From my feeling, that fits very well. Therefore, the trust that we must have in the team, is absolutely justified. We feel we are really in good hands here.

You are now the first complete day in the hypoxia chamber, at a quasi-altitude of about 3,700 meters. Does it feel different than on a mountain?

Of course, it’s different because the hardness factors such as strong sunlight, wind, cold, storm or snow fall are missing. So, of course, it’s much easier. But the thin air feels as we know it from high altitude – although the height is simulated by reducing the oxygen content. Normally, this percentage is always the same, no matter how high you are. (The hypoxia is caused by the lower pressure with which the oxygen is pressed into the lungs.) Here nitrogen is pumped into the rooms and thus the oxygen percentage decreases.

Do you think that you will learn something about yourself in the next few weeks?

Mobile climbing wall in the living area

I have already learned a lot. There are many, many little things. For example, we trained on the mobile climbing wall yesterday. It was specially set up for us here because we wanted to stay fit while climbing. We immediately noticed that not the lack of power in the arms or fingers will be the limiting factor, but the stamina in the thin air. We underestimated that. If we climb the overhanging part of the wall here, we’ll probably never get to the point where we run out of energy, but we’ll be at the limit in terms of endurance.

Does it help you to get through the whole thing as a couple?

That definitely makes it a lot easier. Yesterday at dinner I briefly imagined what it would be like if I were sitting here alone, maybe watching the news and then going to bed by myself. That would be terrible. You do not have anyone to talk to about what happened during the day. Being able to do this together with your partner is really great. We have a lot to laugh about. But we had also the first difficult moments during the night. Nancy suffered from headache, I had a slight pressure in my head. You talk about it, and then it’s a bit easier again.

Is it a bit like sitting in a base camp in bad weather and not being able to avoid each other?

You can really compare it. I remember for example 2009, when we were stuck in Lhotse Base Camp for three weeks in extremely bad weather and could only switch between our personal tent and the mess tent. It’s not much different here. However, we actually have more space to move, because the rooms here are very spacious. In addition, we have a lot of tasks to do during the day.

Ralf has a ECG

What do you expect, how will you come out of this experiment? As a physical wreck?

That’s the big unknown. We originally planned to go on expedition afterwards and use this extremely good acclimatization. However, cause we have no idea whether we are still fit enough to climb an interesting mountain, we have limited our plans to the Alps. There are e.g. on the south side of Mont Blanc so many high-altitude destinations. If we’re still fit enough, we’d rather go there instead of buying a permit, having to pay a liaison officer in advance, and then maybe having to say: We’re too weak, it’s just not possible.

But it’s also possible that you will be just lazily lying in the sun?

It’s possible too. After the time here in the chamber, the trade fair “Outdoor” will take place in Friedrichshafen. After that we’ll have a bit of time left without obligations. Maybe then we will be lying in the sun.

Hypoxia training at home for Mount Kilimanjaro

Mount Kilimanjaro is calling. In three weeks I will set off for the highest mountain in Africa. Of course I want to reach the summit at 5,895 meters. But that’s not the only reason for the “Kilimanjaro Summit Challenge”. The other 23 expedition members and I will also participate in a research project of the Philipps University Marburg on altitude sickness. The doctors who will accompany us will take blood samples and examine us daily. Also psychological tests are planned. The risk of suffering from high altitude sickness on Mount Kilimanjaro is quite high. Finally, the summit aspirants overcome an altitude difference of more than 4,000 meters in just a few days. About 70 percent of the Kibo tourists say they suffered from symptoms of acute altitude sickness.

Breathing thin air at home

Immediately after training: oxygen saturation 87 percent, five minutes later 98 percent again

I live in Cologne at about 50 meters above sea level, the Alps are about 600 kilometers away. So I miss the opportunity to just climb a mountain and breathe thin air. Even before my previous expeditions, I had good experiences with hypoxia training, back then in special gyms. Now there is a generator in my home, which I can specifically use to filter out a part of the oxygen from the air. Through a mask I inhale the oxygen-poor air thus simulating a higher altitude. So I am not only able to breathe thin air during training and at rest, but even sleep in a special small tent in “high altitude”.

Thomas Huber, Jost Kobusch …

Meanwhile, some commercial expedition operators are also using such equipment to give their customers the opportunity to acclimatize before the expedition. I borrowed my device from Markus Göbel. The 41-year-old sports scientist who lives in Sonthofen in the Allgäu region, does not only lend this equipment, but also creates training plans. His clients included the German top climber Thomas Huber and high altitude mountaineer Jost Kobusch.

Markus, it feels like hypoxia training has come into fashion.

It has been increasing.  Six and a half years ago I started with two devices. Meanwhile I receive more and more inquiries. These travel destinations are popular. Some people have never had anything to do with high altitude and are glad that they can prepare themselves at home. The others have experience with the training and know it helps them.

What is the body to believe when doing hypoxia training?

Mount Kilimanjaro

In principle, the same as on the real mountain. There the oxygen molecules in the air are further apart due to the lower air pressure, so I am only able to breathe fewer molecules. With the hypoxia device, the generator filters the oxygen out of the surrounding air via a membrane. To simulate an altitude of 4,000 meters, we then have instead of 21 percent only 13 percent oxygen content. So the molecules are missing just like on a real mountain. The effect is even stronger because here we have to breathe against the normal ambient pressure. This means that the oxygen saturation at real 4,000 meters are slightly higher than at the artificial altitude. So the training effect is even stronger than at the real altitude.

Does the body remember that?

He has to adapt to the lack of oxygen just as on the real mountain. I can not sleep in the hypoxia tent at 4,000 meters all of a sudden, but have to gradually increase the height. So I start, for example, at 2,300 meters and then increase each night by 300 meters, also taking breaks to regenerate. The body remembers the acclimatization for ten to 14 days. I ensure that the customers really use the system until the day of departure, so the gap does not get too big.

Commercial operators report that expeditions which doesn’t take more than four weeks can be sold well, longer ones are more and more problematic. Does this increase the need for hypoxia training?

That’s exactly what it’s about. You anticipate at home the time that is missing on the spot. E.g. for Mount Kilimanjaro, I do two to three weeks altitude training at home and then spend a week there. In total that’s three to four weeks. According to high altitude medicial findings, this is the period of time I need to reach the summit of an almost 6,000-meter-high mountain safe and sound – leaving out other factors such as possible illnesses like diarrhea ond cold, or the weather. I think that customers who have completed an altitude training before a Mount Kilimanjaro expedition have a 95 to 98 percent chance of success.

Thomas Huber doing hypoxia training

Is hypoxia training meanwhile accepted by professional climbers too?

I already had some. (laughs) But they are not knocking my door down. I think, and I find it’s alright, that they don’t want to peddle it. It’s not about saying I’ve done altitude training, so now I’m running up the mountain fast. It is simply a training method to prepare for a mountaineering destination. I do not necessarily have to tell it everyone and their dog and maybe increase the peer pressure to reach the goal. They just do not shout it from the rooftops when they do it.

Olympus Mons, giant mountain on Mars

Compared to the highest peak on Mars, Mount Everest is a dwarf. Olympus Mons rises 26 kilometers above the surface of the red planet. However, this is not the reason why the German Aerospace Center (DLR) deals with high altitude sickness. For a – as I find, very interesting – study, the DLR is looking for mountaineers, who will ascent in the period from 7 to 20 August after a night on the Gnifetti Hut (at 3,647 meters) to the Margherita Hut. The “Capanna Regina Margherita” is located on the summit of the Signalkuppe in the Valais Alps and is, at 4,554 meters, the highest building in Europe. The DLR scientists want to find out whether it helps against high altitude sickness if climbers are sleeping with a raised upper body. The test persons will use wedge pillows, which ensure that they are raised by 30 degrees. In intensive care units in hospitals such pillows have been used successfully for a long time.

Mountaineers who want to participate in the study at the Regina Margherita mountain hut in August can either register by email at ams@dlr.de or register at the valley station in Alagna or the Gnifetti Hut with the DLR study supervisors. I have talked to Dr. Ulrich Limper who heads the study. The 35-year-old doctor has been working at the DLR for three years.

Dr. Limper, why is an aerospace center interested in the health problems of mountaineers? Are there similarities between astronauts and climbers?

Ascent to the Margherita Hut

Let’s start with the astronauts: They have problems with their eyes when they return from long-term missions in the space station. This is called the “VIIP (Visual Impairment and Intracranial Pressure) Syndrome”. Sight is restricted. It has been found that in weightlessness the blood is pumped to the head and stays there because gravity is missing which could pull it down again. High altitude sickness has a very similar cause. If there is a lack of oxygen, the arteries, the vessels which lead to the brain, dilate in order to transport even more blood to the brain. The veins, which carry the blood back from the head, obviously do not have the capacity to dilate accordingly. Therefore, the blood accumulates in the head, leading to the usual symptoms of high altitude sickness such as nausea and headache.
Furthermore, in the future astronauts e.g. on missions to Mars will stay in artificial atmospheres similar to those in the high mountains: low pressure, up to a certain level also lack of oxygen. This makes it so exciting for us as space physicians to think about mountaineers.

Capanna Regina Margherita at 4554 meters

This suggests that mountaineers should be super-qualified to set off for space.

Of course these are quite different challenges. But, in principle, you are right. High-altitude climbers are often very cool-headed people who can deal with extreme situations and can act very rationally. Whenever the European Space Agency is looking for new astronauts, in a first step they hand out a questionnaire, where these things are queried. You can score points if you climb or dive in your spare time, doing all these things where you have to control your body.

A pillow under the head as a recipe against high altitude sickness? That sounds almost too simple to be true?

It is a very pragmatic approach. We do not assume that we can avoid high altitude sickness, but it should be a puzzle part in the overall concept. We want to show that the people who use the pillow as something like a physical therapy are less likely to suffer from altitude sickness than those who don’t use it. We assume that at night the blood accumulates in the head even more, because you are lying flat. That’s why mountaineers feel even worse in the morning than in the evening. This was proved by a study we made last year.

The approach is not new. I quote from a book on high altitude adaption by the German physician Klaus Mees from 2005: “It is often helpful to raise the upper body, e.g. with a backpack or clothing below the sleeping mat or sleeping bag.”

Everest ER

It’s true, this recommendation exists. But we also want to prove scientifically that it works. If you spend a night in a mountain hut, you will not find anyone who really does it. Even if you look on Internet at pictures of climbers suffering from high altitude sickness in Everest Base Camp or elsewhere: They all lie completely flat, wear an oxygen mask, have  a saturation clip on their finger, but almost no one’s upper body is raised. If we can prove that sleeping with a raised upper body is really a simple and effective measure against altitude sickness, we could make the case for it even more vehemently.

You will only record the test persons’ oxygen saturation and pulse and use a questionnaire to investigate the symptoms of altitude sickness. Is this method not too rough to capture the micro-processes that may occur in the brain?

We will not be able to say anything about the mechanism of altitude sickness, but only about this: Does the method work or not? If we were to explore the mechanism, it would make more sense, instead of going to a mountain hut, to use an DLR altitude chamber, where all conditions can be controlled and the micro-processes can be looked at. However, our study has a very pragmatic approach. Every mountaineer will benefit if we prove the success of the therapy – or not. Therefore, it makes sense to carry out the study as simply as possible. We do not take any test persons to the mountain, but work with climbers who are on the huts anyway. We assume that the less they feel burdened in their mountaineering, the more they will join in.

If your hypothesis is correct, the wedge pillow should be in the rucksack of every high-altitude climber and Mars astronaut, shouldn’t it?

It would be at least not wrong to take it with you.

Kilimanjaro

According to the statistics, Kilimanjaro is one of the top mountain destinations in the world. Every year tens of thousands of people tackle the highest mountain in Africa. In 2016, reportedly, more than 30,000 visitors have reached the highest point at 5,895 meters. The “Kibo” is said to be a trekking mountain, several easy routes lead to the summit. Only during the rainy seasons in April/May and October/November the tourist flow decreases a bit. Many operators offer hikes to the roof of Africa as a week trip – this short stay also ensures that the mountain is so popular. However, it is less known that every year several hundred tourists suffering seriously from high altitude sickness have to be rescued from Kilimanjaro, and about two dozens of them die, in some years even significantly more.

4000 meters up in a few days

Christian Kreisel

The Tanzanian government keeps the exact number of deaths under cover. If they became known, this could damage the booming mountain tourism. Many people simply underestimate the risk of getting altitude-sick on Kibo – though it’s actually obvious: After all, the summit aspirants have to overcome more than 4,000 meters in altitude within a few days. The physician Christian Kreisel from the University Hospital of Gießen and Marburg now wants to develop a faster and reliable diagnosis of high altitude sickness – with a study on Kilimanjaro. The tests have so far been too coarse meshed, says the 37-year-old, who has climbed the mountain already six times: “I want to reduce the mesh size of the sieve.”

Numerous tests

Kreisel is looking for 25 athletes who participate in the study – mountain bikers or mountain runners. From 24 September to 1 October 2017, they are to climb the highest peak in Africa. A three-day training camp is planned at 3,700 meters, an overnight stay at 4,800 meters and a summit attempt. Before and during the trip, numerous medical and also psychological tests will be made. At the same time, the athletes receive data on their performance at high altitude, which should also be useful for their future mountain sports projects.

“Up to now, pursing sport seriously on a mountain like Kilimanjaro was a dream limited to just a few elite athletes,“ says Rainer Braehler, organizer of the “Kilimanjaro Summit Challenge”, “but with this study, ambitious amateur athletes can now test their limits at very high altitudes – with the reassurance of full medical supervision”. Those who are interested in taking part, find the details and can apply on the website of the project.