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acclimatization advice for crossing the Thorong La

This is an accompaniment to Trailblazer's Trekking in the Annapurna Region guide book.

In my experience the following recommended itinerary doesn't offer safe acclimatization for many people. This itinerary is recommended in both Trekking in the Annapurna Region by Bryn Thomas, Trailblazer and Trekking in the Nepal Himalaya by Stan Armington, Lonely Planet.

The usual advice

Overnight stops: Pisang - Manang - Manang - Ledar - Thorung Phedi - Muktinath

This itinerary does work for some people BUT an HRA (Himalaya Rescue Association) study found that something like 65% of trekkers surveyed who had followed this approach had suffered moderate altitude sickness (ie worse than mild altitude sickness).

This means that a significant number of people also suffer dangerous altitude sickness. I have witnessed people with ataxia, suffering hallucinations and build-up of fluid in the lungs. These people were perhaps 24 hours away from death, except that they descended, the best cure for altitude sickness.

Strangely, the HRA has yet to modify the advice it gives to trekkers about the best acclimatization plan.

My safer approach

Overnight stops: Pisang - Manang/Braga - Manang/Braga - Yak Kharka - Ledar - Thorung Phedi - Muktinath

I compared approx 30 trekkers who followed this safer itinerary with approx 30 trekkers who followed the fast itinerary (conveniently a snowfall provided a delay). I was surprised: nobody who followed the safer approach experienced any moderate AMS symptoms. While among the trekkers who caught us up and took the fast approach, perhaps half the trekkers suffered some problems, one serious enough that he knew he was in real trouble 3/4's of the way up the pass and so dumped his backpack for friends to carry. At least two people turned back because they were suffering AMS at Thorung Phedi.

Thorung Phedi High Camp

Since around 2000 there has been an alternative lodge to the sprawl at Thorung Phedi. It is often called "High Camp" and is around 200 vertical metres above Thorung Phedi. While this extra height means less gain over the pass, it also significantly increases the risk of altitude sickness unless you are well acclimatized.

My conclusions

the high routeVery few people have died taking the fast itinerary but many, many people have suffered worry, stress and various degrees of altitude sickness. A surprising number of people don't make it over the pass using the fast itinerary. The safer approach is more comfortable, less stressful and SAFER. You trek to enjoy!

High route or Low route between Pisang and Manang?

The best itinerary takes in the high route between Pisang and Braga-Manang:

Pisang

Ghyaru and/or Ngawal

Braga/Manang

Manang...

And, of course, this is also better altitude preparation for the pass...

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