The short version : adapting to high altitude takes time. You can travel to Lhasa fast , and spend time in hangover country before coming closer to full capacity again. The other option is to spend some time enroute , and get more out of each day. This should be an easy choice for anyone who has more time than money , since the time in Tibet will be the most expensive days on any trip to China.
Train , as in the nonstop Beijing -Lhasa run , or flying in , also from Beijing , are the options most will chose between The benefits or risks are the source of intense speculations , but with the massive numbers of travellers to Lhasa there is also some hard data now.
Reality check : one in three will get altitude sickness , coming in by train from Beijing .
And this is good news : twice as many get it on flyins.
The high figure for AMS is a shocker for many , but is in the same order for Cusco travellers , and a 2011 study from Lhasa, which also found that AMS was more common on flyins. Early stages are of AMS are undramatic , and many won’t even think of the hangover like situation as sickness. On the other hand a few , depending on bad luck in the genetic lottery in combination with really fast ascent do get severe AMS. The rare and worst case scenario is pulmonary edema , which only appeared in the flyin group – see the notes and reading suggestions below.
There is a rich flora on speculations regarding the train vs plane issue , the main reasons given for not taking the train being that it a) runs too low for benefit , or b) it runs too high . A conservative plotting of altitude as the available amount of oxygen , factoring in the extra oxygen on the train , gives this elevation profile between Xining and Lhasa :
TO LHASA IN TWO OR THREE DAYS :
Fly in to Xining at 2283 meters , sleep minimum one night there . Every extra night at 2000+ is a major positive factor. Next leg of the trip to Lhasa by train or plane . The reason you probably haven’t heard of the flyin option from Xining is that you couldn’t , until this year. Train is still better than the plane , from two reasons : you get more time between Xinings and Lhasas altitude , and you spend your first day at 3000+ meters at rest. Think of it as being locked up in a Lhasa hotel room , with a oxygen tank by your bed . And with a lot better views.
TO LHASA IN ONE DAY :
Fly in from one of the international airports Beijing , Kunming or Chengdu . Obviously not my recommendation for firstcomers to high altitude – the chances of getting really sick are low , but the chances of the first day or two being spent in hangover country are excellent.
TO LHASA , THE INTERESTING WAY :
The really good news here is that there are a number of interesting options that are even better than the two day options , if you are willing to spend more time .
Take the train from Lanzhou , near the Beijing-Lhasa halfway point at Xining, and add acclimatization time at Labrang. Lanzhou is at 1600-ish meters , which is too low for effective acclimatization. Labrang monastery , an important pilgrimage site for Tibetans , is only a few hours away with bus , at 2945 meters.
Kunming ( altitude 1850 ) : International airport , and railway point.
Still too low for effective acclimatization , but a convenient gateway to the large Kham Tibetan region in Yunnan. Take the train to Lijiang @ 2400 meters ( and a day tour on the worlds highest cable car ) , onwards to Shangri La/Gyalthang .
Shangri La old town was very interesting until a few months after my visit , when a massive fire destroyed most of it. Lots of other good reasons to visit the region – see Losangs blog for a wealth of information on Kham and Amdo regions.
Chengdu : International airport (CTU) , and railway.
Chengdu is abysmally low , but gives easy access to higher ground in the Kham Tibetan region. Kangding/Dartsedo is reached same day with bus. Despite it’s modest altitude at 2600-ish meters Kangding is serviced by the third highest airport in the world at 4280 meters , so you can boost your acclimatization by flying back to Chengdu and take a flight to Lhasa . A cheaper , more environmentally friendly day trip to 4000+ is taking the cable car from near the town center.
ACCLIMATIZATION , AMS AND TRAVELLING TO LHASA :
The medical issues with travelling fast to 3000+ meters altitude are well known since decades back – see the guidelines from International Society for Mountain Medicine or CDC. With litterally millions coming in to Lhasa every year , two million by train , it’s now also possible to make large scale comparisons between different travel modes , with comparable groups.
Incidence of High Altitude Illness Among Unacclimatized Persons Who Acutely Ascended To Tibet ( Yeshung Ren et al in High Altitude Medicine & Biology )
This describes the results of monitoring flyins to Lhasa in a 3268 strong group of military personell. 57 % had various degrees of AMS , 12 % vomited and received medical attention , 2 % started to develop pulmonary edema.
A Survey of Acute Mountain Sickness And Vital Signs in Subjects Ascending To Lhasa Via The Qinghai-Tibet Train ( Younjun Luo et al in Scientific Research and Essays )
A similar group of military personell , forty nine persons , was closely monitored during the train ride and for a long period in Lhasa . AMS peaked in 14 % of subjects during the first three days in Lhasa. Worst outcome , in four out of fortynine , was a AMS score of 4 at the Tangu La pass high point and first and second day in Lhasa. One person vomited at the Tangu La. None developed pulmonary edema.
Altitude Illness in Qinghai-Tibet Railroad Passengers ( Tian Yu Wu et al in High Altitude Medicine & Biology )
Tian Yu Wu was a key figure in planning the health program for the workers constructing the railway to Lhasa , the worlds largest construction project at extreme , up to 5000+ meters , altitude. The key data here comes from 160 random Chinese lowlanders travelling straight to Lhasa , without any acclimatization stop at Xining. 31 % developed AMS , 4 % vomited at the Tangu La. Worst outcome : one person developed a balance disorder , which improved after receiving extra oxygen. He was given intermittent oxygen at Lhasa hospital , a clean bill of of health after a CT scan of the brain , and resumed his Lhasa tour after a single day of observation in the hospital.
Acute Mountain Sickness among Tourists in Lhasa, Tibet – A prevalence study ( Labazangzhu , from Oslo University )
This is the result of survey among around two thousand tourists in Lhasa , nearly half Chinese , which gives a narrow advantage for the train and shows a AMS incidence of 51 %. It has a number of problems making valid comparisons . It includes many different travel modes , persons normally living at 2000+ meters , and for example people travelling from Kathmandu in Nepal , which will include both unacclimatized persons coming directly from Kathmandu , and well acclimatized persons after trekking at 3000+ meters.
AMS is obviously common enough on both the nonstop train run and flyins to Lhasa to consider medicating with Diamox. Talk it over with a travel doc , not your GP. In China you will invariably be offered Rhodiola/Hong Jian Tin instead , which has no documented effect ( including the few who used it on the the train in Wu’s study ) . Rhodiola is often presented as a unique Tibetan herb and tradition : it’s not . The plant is found over large parts of Asia and Europe , including my home mountains near the Arctic Circle and the Pyrenees . It has been known to western tradition from the first century greek physician Dioscorides , was renamed by Linnaeus in the 18th century , and became a part of the Stalin era medical research in the twentieth .
The adjusted elevation profile comes from recalculating the effective altitude from the inspired amount of oxygen on the train , factoring in the higher oxygen concentration after Golmud . John B West , editor of High Altitude Medicine & Biology , measured the O2 concentrations on one of the first runs of the train , and calculated the effect to a 900-1200 meter lowering of the effective altitude. I plotted it as one thousand meters lower , with a build up factor during the first 100+ klicks after Golmud – which still are lower than Lhasa on the map.