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Peaks of the Gyamshu massif as seen from the Zalung Karpo La (Trek 1)

Continuing to ascend with any persistent symptoms can lead to the serious risk of pulmonary and cerebral oedema, or even death; sometimes complications from altitude sickness can strike very quickly. There are deaths each year in the Himalayas, where the criterion is ‘Descending is the only safe cure, at any time of day or night.’ However, in Ladakh descent is not an option in all locations. It is therefore of the utmost importance to acclimatise before going higher. For this reason, many groups spend a few days sightseeing in and around Leh before starting their trek.

What else can you do to ward off the effects of altitude? Many trekkers start a course of Diamox (Acetazolamide), a diuretic that thins the blood, makes you urinate more and is generally considered to be of some benefit, although it can have the disturbing side-effect of pins and needles in the fingers. Another option is to try coca. Not the smoking variety, but a version of the substance used by natives of Peru and Bolivia. Coca is available as homeopathic tablets that some trekkers swear by. It can be difficult to locate these in the UK, but French pharmacies stock them, should you be limbering up in the Alps before your trip. Also recommended by some are ginkgo biloba tablets, which appear to work for reasons not yet defined. It is suggested that these can be taken twice a day for five days before arrival and once a day during the trek, but consult your doctor beforehand as they can affect blood count and are not suitable for everyone.