Living at Elevation – How to Adjust for Optimal Health

by Sophie Samiee

Many of us reside here in Santa Fe because we love the high desert: the clean air, four seasons, opportunities for recreation, and the unmatched beauty of the natural environment. But living at elevation has its challenges, too, including cold winters, hot summers, dry air and low air pressure, which results in lower oxygen concentration than at sea level. Our high elevation also puts us closer to the sun, for greater sun exposure with a higher ultraviolet index, year-round.  

Given the climate of Santa Fe, residents’ bodies have developed clever ways to adapt with increased hemoglobin levels, which helps us use oxygen more efficiently, reducing strain on the heart. This is immediately apparent when you travel to sea level and enjoy a boost in athletic performance, strength and recovery.

In general, these adaptations are favorable, resulting in four-to-five years’ longer life expectancy. 

So, how to enjoy the benefits of living at elevation, while guarding against the challenges inherent in our environment? Here are five adjustments we recommend to optimize your health:

1. Stay Hydrated

Because of the decreased oxygen, breathing is typically heavier at elevation than at sea level, especially when hiking. As a result, with each breath, we lose water. Also, sweat evaporates easily and often goes unnoticed. 

Under normal sedentary conditions, most people are aware of thirst, but with an active lifestyle, regular exercise, medication, or older age, our ability to detect when we need to drink is less reliable. Vigorous exercise at high elevation amplifies this phenomenon. 

Here’s what to do: 

• Drink regularly – Drink fluids (mostly water) at regular intervals rather than waiting and drinking a lot at the end of exercise.

• Eat plenty of fruits and vegetables – Water-packed foods deliver hydration slowly and include electrolytes and micronutrients, too. Many fruits and vegetables also have antioxidants that mitigate the stress of living at elevation. 

• Water up high, electrolytes down low – Those who live at high elevation should expect to sweat more at sea level. Therefore, drinking fluids laden with electrolytes is important at sea level – while water is more important at high altitude because of evaporation through the lungs.  

Cautionary note: There is a limit to how much water the body can tolerate. Too much water can result in hyponatremia, which results in confusion, discoloration and seizures. The rule of thumb would be three-to-four liters a day with 50-to-100% increase with extreme exertion. 

2. Be Aware of Sun Exposure

Sun exposure is the main pathway to create vitamin D, which helps the body absorb calcium for healthy bones, supports immune health and helps keep muscles and brain cells working. The sun also boosts mood, supports sleep cycles, and increases nitric oxide production from the skin, which benefits blood vessels. It also influences the skin microbiome to release nitric oxide to fight unwanted bacterial infections. 

Because UV, and UVB when the sun is at the correct angle, is higher at elevation, we get the benefit of faster vitamin D production – but we’re also at risk for sunburn and increased skin cancer. 

Here’s what to do:

• Soak up the sun – For fair skin, only a few minutes in the sun will provide enough exposure for good vitamin D status. In contrast, people with a range of darker skin tones may require anywhere between 5 and 30 minutes to get the same benefits.

• But not too much – Seek shade, wear protective clothing (long sleeves, dark, tightly woven fabrics), use broad-spectrum SPF 30+ sunscreen and reapply often, wear wide-brimmed hats and UV-blocking sunglasses. Remember that UV protection is needed even on cloudy days. Avoid tanning beds entirely.

3. Optimize Oxygen During Sleep

Breathing, in general, helps maintain the delicate balance of oxygen and carbon dioxide in the body. When we’re at high elevation our breathing rate increases, which brings in more oxygen. The increase in oxygen means a decrease in carbon dioxide – and when the amount of carbon dioxide in the body is lowered, the drive to breathe declines. At night, this can result in bouts of apnea that can disrupt sleep quality. 

Reduction in sleep quality is most significant immediately upon arriving at high elevation – but research has shown that reduced sleep quality can persist even after years.

Here’s what to do:

• Practice, practice, practice – The ability to take deep easy breaths while asleep is the best protection against poor sleep at altitude. Practice a few deep complete breaths (singing or humming may also be effective) before bed to stretch out the chest wall, and include deep breathing as part of your overall health practices. 

• Sleep posture – You can improve sleep posture by sleeping on your side or elevating your head to keep airways open and prevent obstruction.

• Modify your environment – Use a humidifier to add moisture to the air to reduce congestion and improve airflow. Keep your bedroom fresh by opening windows or using houseplants to increase oxygen in your room.

4. Take Supplements for Improved Focus: Folate (B9) and Choline

Living at elevation can impair focus, attention, and cognitive function due to lower atmospheric pressure and reduced oxygen (hypoxia), which affects brain performance. This can lead to slower reaction times, impaired memory, decreased executive control, and increased mental fatigue, often causing difficulty focusing on complex tasks.

Studies have shown that creatine supplementation supports better energy delivery and may protect neural excitability when exposed to low-oxygen environments like high elevations. 

In addition, homocysteine, an amino acid naturally produced in the body, can be higher at elevation and has been correlated with decreased cognitive function. 

Here’s what to do: 

• Eat food high in creatine – To get more creatine, eat foods high in it like red meat, fish, and poultry.

• Choline supplement – A creatine supplement such as choline provides much higher doses than diet alone, with the body also naturally producing some daily. 

• B vitamins and folate – Supplementing with vitamin B12, B6, and folate helps reduce elevated homocysteine, which can slow brain atrophy in individuals with mild cognitive impairment.

• Talk to your provider – Before you make any changes in supplements, talk to your healthcare provider to ensure it's right for you.

5. Temper Alcohol 

While the potency of a drink does not change with elevation, the body’s perception of drunkenness does. When dehydrated, which is common at high elevation, there’s less water in the blood to dilute the alcohol. After entering the bloodstream, the alcohol travels to the brain and creates the feeling of drunkenness faster than if the blood were less concentrated.

The effects appear more severe upon first arrival at high elevation. You may have had house guests who get too drunk on their first night in Santa Fe: In addition to being dehydrated, they may also be experiencing symptoms of mountain sickness – headache, nausea and dizziness.

Here’s what to do:

• Prioritize hydration: Drink six to eight glasses of water daily, or more if drinking alcohol, as dry, thin air increases moisture loss.

• Take a shot (of olive oil) – Drink one-half shot of olive oil prior to drinking alcohol – then drink alcohol slowly, interspersed with glasses of water.

If you’re concerned about the effects of living at high elevation, consult your Cloudberry provider. Many of us are lifelong residents of The Land of Enchantment and are happy to help you adjust for optimal health.

Sophie Samiee works as a fact checker for WNYC podcasts Radiolab and Terrestrials. She recently completed work at the malaria lab of the University of California, San Francisco, and now resides in New York City, pursuing a career in health communications.