Altitude sickness on the Inca Trail — what actually helped me
Advice
Just got back from this with Intrepid. I was pretty anxious about altitude beforehand so sharing what worked since I wish someone had written this up before I went.
Before the trek I arrived in Cusco three days early. This was the single most important thing I did. The first two days I barely did anything, just walked around slowly and let my body adjust. Coca tea at the hotel every morning and evening, and I drank way more water than felt necessary, four to five litres a day.
I also got Diamox prescribed before leaving home. Started taking it two days before we began hiking. Brought ibuprofen for headaches, electrolyte tablets, and bought coca leaves in Cusco which are much cheaper there than anywhere else.
On the trek itself the guide set a slow pace and was firm about it when people tried to push ahead. That mattered a lot on day two going over Dead Woman's Pass at 4215m. It was tough but manageable if you don't rush it. Forced myself to drink water even when I wasn't thirsty.
A couple of things surprised me. Sleeping at altitude was actually harder than hiking. Bring earplugs too, the mountain huts are not quiet. The guides carry oxygen tanks just in case but I never saw anyone need one.
The people who struggled most were the ones who flew in the day before and skipped acclimatisation in Cusco. Don't do that. The porters and guides know exactly what pace works, trust them when they tell you to slow down.
Happy to answer questions if anyone is planning this trip.