superb article editorial on this topic in recent Wilderness and Environmental Medicine 23, 207-211 (2012)
here is what they say
"Both acetazolamide and dexamethasone are currently classified as performance-enhancing drugs (PED) by the World Anti-Doping Agency (WADA)"
Diamox (acetazolamide) facilitates or speeds up acclimatization. While it does not make you run up the hill any faster when you are well-acclimatized, it does help you feel better enough to go faster (or at all) when you are not yet acclimatized. Of course, that is when you use it, early on. So for some of the time, yes, it improves performance relative to a non-treated person ill with AMS .
Dex is different. It too helps you feel better by covering up the symptoms of AMS, but does not actually speed up acclimatization. Either drug can help you go faster than the next guy who may be on the trail with a splitting headache or puking.
Other drugs are more clearcut beneficial for sports, say taking not a normal dose but a "supraphysiological " dose of testosterone, say 1,000% daily for months. What about taking adrenaline, it can make you go for sure, but what about a small dose for treating your asthma? is that cheating? What about taking a small dose of Dex (or prednisone or cortisone) for tendonitis? Is that a medical treatment alone, or is a also a PED? Yes.
Even the Lance Armstrong thing is unclear. If all he was taking was EPO (erythropoetin) to build more blood (blood doping) it is not even clear if that helped. Despite popular opinion, more red blood cells can be counterproductive to performance. That has of course been studied in high altitude medicine. At the Ex Ped Med conference recently , world high altitude expert Peter Hackett reminded us that it was not the amount of blood that mattered as much as how it picked up, delivered, and then releases the oxygen - these are factors that go beyond simply the amount of hemoglobin alone.
as for me, yes, I cheat and take Diamox. When I go with Richard P next week and spend the first night driving up to the Toluca hut at 14,000 the first night, you better believe I will take Diamox. And since my 11-month old total knee still has swelling, I will be talking some steroids. Cheater, yes. Feel guilty about it? No
If your trip to Nepal includes a day or two in Kathmandhu, then a flight to Lukla at 9,300ft then you will be a bit slow wandering around the first day. If you are taking 2-3 days to get to Namche 11,200 ft, then you should acclimatize on your own without Diamox ,although a little extra "edge" is reasonable. If you are heading east out of Lukla then you will be climbing faster . Where are you going?
Harvey
