1. When is adaptation complete on ascent to high altitude ?
Gustavo Zubieta-Calleja (Jr)
Gustavo Zubieta-Castillo
High Altitude Pathology Institute
Clinica IPPA
La Paz – Bolivia

2. The definition of adaptation to high altitude
“The organic systems of human beings and all other species tend to adapt to any environmental change and circumstance, and never tend towards regression which would inevitably lead to death”.
Gustavo Zubieta-Castillo Sr.

3. The High Altitude Adaptation Formula
time
Adaptation to high altitude =
altitude
For a fixed altitude, the only significant variable is time.
How long does it take to achieve full adaptation to a fixed altitude ?

4. The Mechanisms of Adaptation to high altitude
Macro-systemic
Respiratory
Increased Ventilation
Cardiac
Increased Heart Rate
Pulmonary Hypertension
Micro-systemic
Blood oxygen transport
Hematocrit increase
Increased circulation
Neoangiogenesis
Cellular changes
Increased mitochondrial density
Sodium and Potassium pump changes
Hydro-balance
Neuro-endocrine changes
pH correction

5. Transcription factors
The Mechanisms of Adaptation to high altitude Hypoxia induced gene expression
Transcription factors
Hypoxia inducible factor (HIF-1)
Activator protein-1 (AP-1)
Nuclear factor-IL6 (NF-IL6)
Early growth factor (Egf-1)
Nuclear factor kappa B (NFkB)
Relevant target genes
Erythropoyetin
Vascular endothelial growth factor (VEGF)
Tyrosine hydroxylase
Endothelin 1
Genes involved in glucose metabolism
Nitric Oxide synthase

6. The adaptation to sustained exercise
Time dependant
Too acute
lesion

7. OXYGEN TRANSPORT MECHANISMS. V RR VT
RESP. RATE
TIDAL VOL. Hb VS HR .
STROKE VOL.
HEART RATE Q

8. Intermediate Adaptation
Acute
Full
Adaptation
Intermediate Adaptation
Subacute Mountain Sickness
CMS
AMS

9. Adaptation and Diving
time
Adaptation to diving =
altitude
depth

10. Conclusions
Immediate adaptation to high altitude is possible but is not
optimal nor definitive.
The optimal adaptation is achieved only when the hematocrit
reaches the plateau value.
This value is specific for each altitude and for each individual.
The time lapse depends on the initial hematocrit upon ascent
and on the health status.