How to plan a high-altitude trip to the Peruvian Andes without getting sick

To avoid altitude sickness in Peru, you must start in the Sacred Valley (lower elevation) rather than flying directly into Cusco, and spend your first 48 hours resting with minimal exertion. Hydrate with at least 3 liters of water daily and consult your doctor about taking Acetazolamide 24 hours before your ascent.

1. Start in the Sacred Valley. Upon arriving in Cusco, skip the city sightseeing immediately. Take a pre-booked car directly to Urubamba or Ollantaytambo (elevation ~2,800m). Staying here for the first two nights allows your body to adjust much more easily than the 3,400m elevation of Cusco city.
2. Implement the 48-hour rule. Do not schedule heavy trekking or high-intensity tours for your first 48 hours. Focus on light walking and gentle exploration. If you feel a headache, stop and rest immediately—do not 'push through' it.
3. Acclimatize your diet. Avoid alcohol and heavy, greasy meals for the first three days. Your metabolism slows at high altitude, making digestion difficult. Stick to light soups, quinoa, and local coca tea, which acts as a mild stimulant for altitude adjustment.
4. Manage your exertion. When hiking, use the 'step-step' method: take one small step per breath. If you are gasping, you are moving too fast. Keep your heart rate low to maintain oxygen saturation.

Is coca tea actually effective?

Yes, locals have used it for centuries. It helps with the mild headaches and nausea associated with early altitude adjustment.

Should I take medication?

Consult your doctor. Many travelers find Acetazolamide (Diamox) highly effective, but it is a prescription drug and can have side effects like tingling fingers.