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10 Tips for Dealing with High Altitude on Your Trip to Peru

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Peru is a bucket list destination for so many people. From the ruins of Machu Picchu and the Sacred Valley to the city of Cusco and Lake Titicaca, there are so many cool places to see in Peru.

But what many people don’t know – because most people don’t talk about it enough – is that almost all the main touristy sites throughout Peru are at very high altitude. And we’re not just talking Grand Canyon or Denver altitude; we’re talking above 10,000 feet high elevation!

And if you’re a sea level-dweller like me, these altitudes can really mess you up.

Cusco sits above 11,000 feet, and is surrounded by even higher mountains.
Machu Picchu ruins from above
Machu Picchu (7,972 feet) might be one of the lower-elevation spots you visit!

What is high altitude?

High altitude is generally considered to be 8,000 feet (2,438 meters) and above (while “very high altitude” is anything above 12,000 feet). According to the CDC, people are at risk of suffering from altitude sickness at any elevation above 8,000 feet – which is almost every major tourist site you’ll visit in Peru!

For context, here are the altitudes of some of the more popular places to visit in Peru:

  • Aguas Calientes (Machu Picchu town) – 6,690 feet (2,040 meters)
  • Arequipa – 7,660 feet (2,335 meters)
  • Machu Picchu – 7,972 feet (2,430 meters)
  • Ollantaytambo/Sacred Valley – 9,160 feet (2,792 meters)
  • Cusco – 11,152 feet (3,399 meters)
  • Colca Canyon – 11,800 feet (3,597 meters)
  • Lake Titicaca/Puno – 12,500 feet (3,810 meters)
  • Rainbow Mountain – 17,060 feet (5,200 meters) – this is almost at the same elevation as Everest Base Camp!

The only places you’re likely to visit in Peru that are around sea level are the capital city of Lima, and the Amazon jungle!

Vicuñas in front of a snow-capped volcano in Peru's altiplano
Vicuñas in Peru’s altiplano; these guys only live at altitudes above 10,000 feet!

What is altitude sickness?

When you travel to high altitude, this air is “thinner,” meaning there’s less oxygen in it. Altitude sickness is the broad phrase to describe the ways the body can react to lower levels of oxygen at high altitudes.

The mild form of altitude sickness (which is what you may experience in Peru) is called Acute Mountain Sickness (AMS). It’s a temporary condition that will go away – but it can still feel awful in the moment!

Some symptoms of altitude sickness/AMS can include:

  • Headache
  • Fatigue
  • Nosebleeds
  • Poor sleep
  • Loss of appetite
  • Nausea
  • Digestive issues (including vomiting)
  • Fast heartbeat
  • Shortness of breath

And the thing to keep in mind is that ANYONE, regardless of age or fitness level, can experience altitude sickness when traveling to high altitude. Altitude sickness can come for the 20-year-old runner just as often as the 70-year-old cross-stitcher.

Amanda at a stone marker at 16,200 feet in Peru
Me at 16,203 feet – I could definitely feel the altitude here!

How to avoid altitude sickness in Peru

Any trip to Peru comes with the risk that you might experience some degree of altitude sickness. You could also do all the “right” things and still feel affected by the altitude.

BUT, I will say that I traveled to Peru on a guided tour in a group of 10 people from 5 different countries, with ages ranging from 30s to 70s. And no one had any major issues with the altitude in Peru! Part of this could be because we got lucky; or it could be because we followed all the local advice.

Here’s everything I would recommend to avoid altitude sickness in Peru.

NOTE: I’m obviously NOT a medical professional, and this is not medical advice. These are tips gleaned from my own trips to high altitude, which I have not gotten sick during. If you’re concerned about how altitude might affect you, I recommend talking to an actual doctor!

1. Prep for the altitude ahead of time

Now I’m not saying you need to go out and buy an altitude training mask or go spend time in the mountains to get ready for the average trip to Peru. But upping your cardiovascular-focused activity for a few weeks before your trip can really help prep your body for high altitude!

This is a good idea anyway, since many of the historic sites in Peru require lots of walking and climbing steps (looking at you, Machu Picchu!). You don’t need to get out and train for a marathon, but I would suggest doing a little bit extra than you normally would each week.

View of Ollantaytambo from the Temple of the Sun
Want to climb the 200+ stone steps to the Temple of the Sun in Ollantaytambo (9,160 feet)? I’d recommend some cardio training!

If you already work out regularly, make sure you’re adding in some more cardio sessions. And if you don’t work out much at all, consider trying to fit in a couple miles of brisk walking 2-3 days per week. It honestly will help!

(Though if you’re planning to hike the Inca Trail on your trip to Peru, THAT is an activity you will want to more seriously train for! Read about my experience doing the 1-day Inca Trail hike here.)

2. Ascend gradually

It’s widely recommended that you take it slow when ascending to high altitude. The CDC recommends not traveling from sea level to any higher than 9,000 feet (2,743 meters) in one day, and to stay a couple days around 8,000-9,000 feet when possible before going higher to allow your body to adjust.

Many people fly into Lima, Peru (which is at sea level), and then go straight from there to Cusco, which isn’t optimal.

In my case, the tour that I booked (this one with Intrepid Travel) had us travel from Lima (sea level) to Arequipa (around 7,661 feet/2,335 meters) for two nights before moving to higher altitudes.

Arequipa main square
Having 2 nights in Arequipa to adjust definitely helped!

I know this isn’t always possible with a trip to Peru, but if you have a choice in your itinerary, try to choose one that allows you enough time to adjust to the altitude!

3. Hydrate like crazy

It’s a good idea to drink lots of water when you travel anyway, but it’s especially important at high altitude. It’s generally agreed (by doctors, as well as local guides in Peru) that you should be drinking an extra 1-1.5 liters of water per day when you’re at high altitude.

But, this much extra water can flush sodium and electrolytes out of you quickly, so you’ll want to be prepared to replace those. You can drink Gatorade (or any similar drink; they’re all sold in Peru), or travel with some electrolyte packets you can add to your water (I personally like the zero sugar Propel packets – they taste the best!).

Amanda at Sallihua hot springs in Colca Canyon, Peru
And if you decide to visit hot springs at high altitude in Colca Canyon? Drink even MORE WATER.

4. Avoid alcohol

You’ll also be told to avoid drinking alcohol at high altitude. Not only can it dehydrate you even more than it normally would, but the body also processes alcohol differently at altitude. So if you are still going to drink, take it easy!

(You’re also advised to avoid drinking too much caffeine, as it can also dehydrate you. But I personally was not about to give up my daily coffee, and if you’re experiencing any headaches from the altitude, a bit of caffeine might actually help!)

You can still enjoy a wine and cheese tasting at Lake Titicaca – just drink plenty of water, too!

5. Take it easy

When you first arrive at high altitude, you need to allow your body time to adjust to operating with less oxygen. This can take anywhere from 1-3 days on average, so if you can build some downtime into your itinerary, that’s ideal.

In my case, we took things slow in Arequipa for 2 days, and also in Colca Canyon (which is at even higher altitude). A lot of people go from Lima straight to Cusco, which can be rough. If that’s what you have planned, it’s highly, highly recommended that you allow at least 2-3 days in Cusco to adjust to the altitude before doing anything strenuous like hiking.

And what can you do while you’re taking it easy? Honestly whatever you want; there are museums, markets, and more to explore in cities like Cusco. Just go slow, and allow yourself enough time to rest.

Street in Cusco, Peru
Cusco has excellent architecture
Amanda holding a kitten at a cat cafe in Cusco
Cusco even has a cat cafe!

(Please don’t fly straight into Cusco and plan to hike Rainbow Mountain – which, remember, is close to the same altitude as Everest Base Camp! – the very next morning.)

6. Eat smaller meals

Your appetite might be affected at high altitude anyway, but if it’s not, it’s still a good idea to eat smaller meals at high altitude, as digestion takes longer when your body has less oxygen to work with.

Our Peru guide advised us to eat a big lunch and a smaller dinner to avoid any major digestive issues.

Cuy guinea pig dish in Peru
If you want to try cuy, a traditional guinea pig dish in Peru, maybe have it for lunch…

7. Embrace the coca culture

The coca plant is endemic to several countries in South America, including Peru. The plant is most famous for being used in the production of cocaine, however the raw leaves are also an ancient remedy for all sorts of ailments – including altitude sickness*.

Locals in the Andes have been chewing on and making teas out of coca leaves for centuries to help stave off symptoms of high altitude, and you can do the same. You’ll find coca tea everywhere, either made with prepared tea bags, or made just by steeping coca leaves in hot water. You’ll also find all sorts of products and foods made from coca leaves for sale, especially once you get up into the altiplano (highlands). The most popular are coca candies in various flavors.

Coca leaves for sale in Peru
Coca leaves for sale
Coca candies in Peru
Coca candies

NOTE: Just don’t try to bring any coca leaves or products back home with you, as they are not legal in places like the US. But don’t freak out about coca leaves giving you any cocaine-like effects; you’d have to drink something like 200+ cups of coca tea in quick succession to feel any stimulant-like effects at all.

*Do coca leaves *actually* work to prevent or treat altitude sickness? Welllll, there really haven’t been many scientific studies done on the topic. But locals across several countries have used coca for its medicinal properties for literally thousands of years. My favorite way to drink coca tea was when it was mixed with mint, as mint IS proven to help with things like digestive issues and sleep problems, which are also altitude sickness symptoms.

Inca tea in Peru
This “Inca tea” included coca, mint, and more! Tasted entirely like twigs.

8. Take prescription meds

If you have existing medical conditions that might affect your heart or lung health to begin with, OR if you’re just really concerned about high altitude, you can get prescribed medications in advance of your trip that help stave off altitude sickness.

The most common medication prescribed is Diamox (Acetazolamide), which can prevent or lessen altitude sickness symptoms. While the drug itself has some of its own nasty side effects, several people on my Peru tour took it and reported no issues with the altitude.

I personally did not get any Diamox for my trip, but you might decide you’d like to have it! Talk to your doctor about this one.

Path on Taquile Island on Lake Titicaca in Peru
Taquile Island in Lake Titicaca, which is the highest navigable lake in the world!

(It’s always worth speaking with your doctor before a high altitude trip like Peru regardless, especially if you have concerns about it!)

9. Track your symptoms

On our tour, our guide actually had us fill out a form every morning with any altitude-related symptoms we were experiencing, along with recording our blood oxygen saturation levels. This was really helpful, as it allowed us to track any trends – and also see how our bodies were adjusting!

Even if you’re not on a tour or your tour guide isn’t doing this, you can do it on your own. You can find small fingertip pulse oximeters (like this one) on Amazon for under $25. At sea level, a normal oxygen saturation is 95-100%, and you’d start to really worry around 90%. At high altitude, it’s normal for your saturation to be lower; our guide said he wouldn’t get concerned unless someone fell below an 84% saturation, and then only if they were feeling poorly.

Using a pulse oximeter at high altitude
The lowest my oxygen saturation dipped was to around 91% at very high altitude, but here it was at 95%!

10. Be honest about how you’re feeling

Lastly, you really need to listen to your body when you’re at high altitude. Tracking your symptoms and oxygen saturation is useful for this, but you also just need to be honest if/when you find yourself struggling.

If you need to slow down, take a day off, or maybe need more help, you need to speak up about it. On my tour, our guide was always quick to remind us that he was always available to help if anyone wasn’t feeling well, and he was equipped with electrolytes and medication at all times. Every hotel we stayed at also had access to oxygen tanks, just in case.

It’s not some sort of moral failing if altitude sickness hits you hard!

White alpaca in Peru
High Altitude Alpaca says no judgement

What happens if I still get sick?

Speaking of the altitude hitting hard, it’s entirely possible that you could do everything “right” and still find yourself knocked on your butt with altitude sickness. It happens, and it’s not a reflection on you or your fitness or anything like that.

The good news is that, while it certainly sucks, most people get over the worst of their altitude sickness symptoms in 1-2 days as their bodies adjust. (Our guide said 24 hours, but of course your mileage may vary!)

To be on the safe side, I would pack the headache and anti-nausea meds for Peru, and try to build in an extra day or two when you first arrive at high altitude – just in case!


Have you ever traveled to a high altitude destination? What was your experience like?

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