By Miguel Ángel Góngora Meza, Evolution Treks Peru’s Co-Founder

Machu Picchu sits at 2,430 m (7,970 ft), about 970 m (3,180 ft) lower than Cusco at about 3,400 m (11,155 ft). Most travellers who get altitude sickness on a Machu Picchu trip feel it in Cusco or on a trek pass, not at the ruins.

I have walked these mountains since 1996, first as an Inca Trail porter and then, from 1998, as a guide. I have seen strong, fit hikers struggle on the passes. The difference is rarely fitness. It is how fast people go up, and whether they listen to their body. These are the altitude mistakes I see most, and what to do instead.

• Mistake #1: Doing your own thing instead of a proven acclimatisation plan
• Mistake #2: Believing fitness protects you
• Mistake #3: Filling your first 48 hours
• Mistake #4: Treating coca tea as medicine
• Mistake #5: Buying pills and oxygen instead of seeing a doctor
• Mistake #6: Hiding a headache to keep up with the group
• Mistake #7: Not knowing the danger signs
• Mistake #8: Going higher with symptoms
• Mistake #9: Thinking Machu Picchu is the high part
• Mistake #10: Skipping the doctor for children, pregnancy or health conditions
• Altitude table: Cusco, Machu Picchu and the treks
• A safe acclimatisation plan
• FAQs

Mistake #1: Doing your own thing instead of a proven acclimatisation plan

Poor acclimatisation can have serious consequences, and we take it seriously. Over the years we have refined one itinerary that, done properly, gets our hikers to the trail ready. Curiously, the guests who skipped it and did their own thing are the ones who have had the most problems with altitude on the trail.

Our acclimatisation plan before the Inca Trail

Two nights in Cusco let your body meet the altitude while you explore. The night before the trek, you sleep lower, in the Sacred Valley. That is exactly the kind of “sleep lower” step the CDC Yellow Book recommends, and it means a later, calmer start on trek day.

In my Inca Trail lessons I tell the story of two sisters, Ana and María. One slept in Cusco the night before the trek, the other in the Sacred Valley. By the first camp, they were having two very different trips.

My advice

• Follow a tested plan. Two nights in Cusco, then the Sacred Valley the night before the trek.
• Visit Chinchero, at about 3,760 m (12,340 ft), by day on the way to the valley, but sleep lower.
• If you feel unwell on arrival, tell us. The CDC also suggests sleeping lower than Cusco first, and we can switch the order.

Mistake #2: Believing fitness protects you

The CDC is clear: training and fitness do not change your risk of altitude sickness. Ascent speed matters more, and your past reaction at a similar altitude is the best guide.

I wrote about Daniel, the “gym guy”, in my Inca Trail lessons. He was strong, and he still reached Dead Woman’s Pass with nothing left. Fitness helps your legs. It does not give your blood more oxygen.

My advice

• Train for the trail, but plan your days for the altitude.
• On the climbs, walk at a pace where you can still talk.
• Take short, steady steps and rest before you are exhausted.

Mistake #3: Filling your first 48 hours

The CDC advises no alcohol and only mild exercise for the first 48 hours at altitude. Symptoms usually start 2–12 hours after arrival, often the first evening.

In my Inca Trail lessons I tell the story of Sophie, a journalist who walked all over Cusco on her first night. By day 2 of the trek she said, very softly, “I wish I had just rested.” Altitude doesn’t care how excited you are.

My advice

• Walk slowly, especially uphill. Cusco’s streets are steep, and San Blas is a climb.
• Drink water regularly, bottled or treated.
• Do not book a 3 am tour on day 2. Rainbow Mountain can wait until the end of your trip.
• Eat small meals. Caldo de gallina (hen soup) is served from early morning in the soup section of San Pedro Market. Save roast cuy and chiri uchu for later.

Mistake #4: Treating coca tea as medicine

Coca tea (mate de coca) is a traditional Andean drink and legal in Peru. There is no good evidence that it prevents altitude sickness. The CDC altitude chapter does not list it. In a Cusco study of 142 young foreign language students (Caravedo and colleagues, Journal of Travel Medicine), drinking coca tea for prevention was not linked to lower risk. In the same study, 39% had acute mountain sickness.

On our treks, porters take short coca breaks they call jallpar, from the Quechua hallpay, coca chewing. They share leaves, a laugh, and a check that everyone in the crew is doing well. It is a social ritual, not a medicine, and it does not replace a slow ascent.

What coca tea can and can’t do

• It can give you a warm welcome drink and a link to Andean tradition. Coca has cultural and ceremonial meaning for many communities.
• According to the WHO’s December 2025 review, traditional coca chewing and tea “do not pose major public-health risks”.
• It cannot replace slow ascent, and it cannot treat the dangerous forms of altitude sickness.
• It can make you fail a cocaine drug test. A 1996 study by Jenkins and colleagues measured about 4.14 mg of cocaine in one cup of Peruvian coca tea.
• It cannot go home with you to many countries. The UK Foreign Office says importing coca leaves or tea into the UK is illegal.

Our coca tea and drug tests guide has the full study numbers and the rules by country.

Mistake #5: Buying pills and oxygen instead of seeing a doctor

Altitude medicine is a decision for a doctor, before you travel. The US State Department’s Peru page tells travellers to consult a doctor about preventive medication.

We do not give doses on this page. Bring any prescribed medicine in its original packaging, with your prescription.

Mistake #6: Hiding a headache to keep up with the group

The most dangerous words on a trek are “I’m fine”. Altitude sickness caught early is usually simple to manage. Hidden for a day, it can become an evacuation.

On the Inca Trail, at Phuyupatamarca, a hiker once told me he felt dizzy “but it’s fine, I can push”. He had barely drunk water. We stopped, checked his pulse and oxygen, and took him down about 600 vertical metres to a lower camp. By the next morning he was laughing, and he finished the trek. He spoke up early, and he trusted the team. I tell the full story in my Inca Trail lessons.

My story: waiting for a helicopter that never came

Many guests ask about evacuation and assume a helicopter will lift them out. On the Inca Trail, that almost never happens. The weather changes fast and the steep terrain leaves very few places to land. In my experience, no helicopter service has operated in Cusco for tourist flights or trail rescues for some years.

In 2003 I witnessed what that means. Another group had a client with high-altitude pulmonary edema at Phuyupatamarca. They called for an air rescue and waited. When the helicopter finally arrived, the weather had changed, and it could not even approach.

The team on the ground had lost precious hours waiting, hours that could have taken him down the mountain. We later learned that he did not survive. I have never forgotten it.

When there is an emergency on the trail, it is the porters who get us out, on their backs or on a stretcher, for hours along the stone paths. That is one more reason why treating porters with dignity and respect is not optional.

My advice

• Tell your guide about any headache, dizziness, nausea or unusual tiredness, even before the trek starts.
• Drink regularly, even when you don’t feel thirsty.
• Trust the guide’s decision if they slow the pace or change the plan. That is not weakness; that is how people get home safely.
• Know that evacuation on the trail is on foot. Going down early, on your own legs, is always faster than waiting.

Our guides carry a first aid kit, oxygen, an oximeter, two-way radios and a satellite device. Our groups are capped at 8 people, so a guide can watch each person closely.

Mistake #7: Not knowing the danger signs

The CDC describes three forms of altitude illness. Learn the signs before you go, so you recognise them in yourself or a friend.

Emergency: confusion, stumbling or breathlessness at rest mean descend now and get medical help. Do not wait until morning. In Peru, dial 113 for emergency medical services, according to the US State Department.

In Peruvian Spanish, altitude sickness is called soroche. You will hear the word in hotels, pharmacies and on trek.

Mistake #8: Going higher with symptoms

The CDC rule is simple: never go up to sleep at a higher altitude with symptoms, and go down if they get worse. According to the CDC, acute mountain sickness improves quickly with a descent of 300 m (1,000 ft) or more.

The classic case is Rainbow Mountain on your second day. At about 5,036–5,200 m (16,522–17,060 ft), it is the highest point most visitors reach. I explain why it belongs at the end of your trip in my Rainbow Mountain guide.

My advice

• With mild symptoms, stop climbing and rest at the same altitude.
• If they get worse despite rest, go down.
• With danger signs, go down at once, with a companion.
• Never trek alone. The State Department says remote areas such as Machu Picchu have few facilities for emergency care.

Mistake #9: Thinking Machu Picchu is the high part

Many travellers fear Machu Picchu itself. At 2,430 m (7,970 ft), it is lower than Cusco and lower than the Sacred Valley towns. Most people feel better there than in Cusco.

The real risk is the night in Cusco, or the trek pass before it. On the classic Inca Trail, that is Dead Woman’s Pass at 4,215 m (13,829 ft) on day 2. On Salkantay, the pass is about 4,600–4,650 m (15,090–15,260 ft).

My advice

• Plan your acclimatisation around the highest place you will sleep or cross, not around Machu Picchu.
• Our Inca Trail and Salkantay trek pages list the daily altitudes.

Mistake #10: Skipping the doctor for children, pregnancy or health conditions

Some travellers need a doctor’s advice before they go higher than Cusco.

Altitude table: Cusco, Machu Picchu and the treks

Machu Picchu’s 2,430 m is the UNESCO figure. Laguna 69 is from Andina, Peru’s state news agency. Other figures are commonly published values and vary between sources. The CDC gives Cusco as about 3,350 m (11,000 ft).

A safe acclimatisation plan

Our plan follows the CDC’s principles: go up gradually, sleep lower when you can, and never go higher with symptoms. Above 3,000 m (9,800 ft), the CDC advises raising your sleeping altitude by no more than 500 m (1,650 ft) a day.

See our Sacred Valley guide for the towns and sites.

FAQs

Do people get altitude sickness at Machu Picchu?

Few people do, because Machu Picchu, at 2,430 m (7,970 ft), is about 970 m lower than Cusco. Symptoms usually start in Cusco or on a trek pass.

Is Machu Picchu higher than Cusco?

No. Machu Picchu is 2,430 m (7,970 ft) and Cusco about 3,400 m (11,155 ft).

How many days should I acclimatise before the Inca Trail?

We advise 2 nights in Cusco, then a night in the Sacred Valley before the trek. Dead Woman’s Pass, at 4,215 m (13,829 ft), comes on day 2.

Does coca tea prevent altitude sickness?

There is no good evidence that it does, and the CDC does not list it. It can also make you fail a drug test.

Can fit people get altitude sickness?

Yes. The CDC says fitness and training do not change the risk. Ascent speed and your own past reaction matter more.

Should I take medicine for altitude sickness?

Ask a doctor before you travel. The CDC says acetazolamide can be considered when a fast ascent cannot be avoided, and that sleeping lower than Cusco for 1–2 nights may remove the need for medication.

Can children visit Machu Picchu safely?

Children are as susceptible as adults, according to the CDC. Follow the same gradual plan and ask your doctor first.

Final words: go up slowly, speak up early

After thirty years in these mountains, my altitude advice fits in one line. Go up slowly, and speak up early. The people who struggle are rarely the weak ones. They are the ones in a hurry, and the ones who say “I’m fine” when they are not.

And remember who carries you down if things go wrong: your porters. Want an itinerary built around safe acclimatisation? Contact our Cusco team.

Updated: November 2026