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Ibuprofen & AMS
#22111 03/20/12 09:31 AM
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wazzu Offline OP
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Here's a link to an article about using ibuprofen for prevention of AMS.

There are some limitations to the study, considering the participants only went up to 11k.

Re: Ibuprofen & AMS
wazzu #22112 03/20/12 10:08 AM
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Studies show some success in preventing AMS with the herb Ginko Biloba, even better than ibuprofen in some trials, as good as diamox in other studies. They seem to use a small number of subjects in most of these studies, and the exposure to altitude varies in rate and elevation. I think they need to do better research on these alternatives.

I like the comment from Herbal Ed on the ibuprofen article. He's been making and selling herbal extracts for probably 30+ years. If you've ever been in a health food store, you've probably seen his extracts and other products.

"To prevent or moderate AMS I prefer to go the more natural route. I take regular doses of the extracts of Siberian Ginseng root and Rhodiola root. When in the highlands of Peru I also drink lots of Coca leaf tea. But what works the best of all is frequently breathing in medical-grade oxygen .... esp. when experiencing AMS symptoms and while sleeping. In Lima, Peru small, portable canisters of medical-grade oxygen can be rented from many pharmacies."

Re: Ibuprofen & AMS
wazzu #22116 03/20/12 10:22 AM
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Originally Posted By: wazzu

There are some limitations to the study, considering the participants only went up to 11k.

True, but the official minimum altitude at which altitude illness begins is 8,000 ft. Plenty of people get sick and a few even die at "only" 11,000 ft.

Some, including the Boeing medical department, think it should be lower, ie, 7,000 ft. And, for persons with certain medical conditions, it may be only 5,000 ft. The FAA recommends the use of oxygen above 5,000 ft in general aviation (non-pressurized) aircraft flying at night. The rule is routinely ignored as the main manifestation is partial loss of color vision and pilots figure they can still distinguish a blue mountain from a green one.

Re: Ibuprofen & AMS
wazzu #22143 03/21/12 11:41 PM
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Ken Offline
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This article is a big problem. I don't expect that people would neccessarily know these nuances, but there are a lot of problems with the interpretation of the data that is presented in the actual paper, and I do not think that it supports the conclusion that is being headlined. I'm a statistician, so I look at these things carefully.

For example, when you look at the actual numbers, there is NO statistical difference between the two groups in rates of headache, which is the basis of the LLC for determining altitude illnesses.

Another example. They state:


Quote:
Quote:Although a decrease in severity of
acute mountain sickness symptoms was found in the ibuprofen
group, statistical significance was not met (Table 2). There were
no statistically significant differences between treatment and
control groups in the secondary outcome measures of headache
severity by visual analog scale or peripheral oxygen saturation
change (Table 3). No differences in significance were observed
between the placebo and treatment groups after adjusting for
age, sex, ethnicity, and oxygen saturation by multivariate logistic
regression.
Subgroup analysis of Lake Louise Questionnaire symptom
prevalence did not reveal statistically significant differences
between placebo and ibuprofen groups in any of the individual
complaints other than gastrointestinal, with greater occurrences
in the placebo group (Table 4).


This is NOT impressive.

There was also another thing that was not really addressed: In the paper, they had a flow chart that showed how they split up the patients. In it they showed at the bottom, the number of climbers who required "rescue treatment" for AMS.

Quite interesting was that only 1 placebo patient required "rescue" treatment, but SIX patients required it
who were taking the Ibuprofen.

That is not success in my book, that is failure.

Additionally, they go on to say:


Quote:
Quote:Our measure of success in preventing severity of acute
mountain sickness suggested that ibuprofen was beneficial,
although the improvement did not meet our predetermined
statistical significance of greater than 2 Lake Louise
Questionnaire points. This endpoint was established as a
clinically meaningful difference;


A clinically meaningful difference means something that actually makes a difference to a person, not just something that is a number on a paper. So what they are saying is that the difference that they observed would NOT, by their own definition, make a difference that the average climber would actually be able to tell.

They also say:


Quote:
Quote:These findings show the clinical effectiveness of ibuprofen as
an agent to protect against acute mountain sickness. Ibuprofen
is a commonly used and well-tolerated medication, making it a
reasonable alternative to acetazolamide in individuals affected by
its adverse effects or challenged by prescription accessibility. We
suggest that availability alone makes ibuprofen an appealing
drug for individuals who travel to high altitudes.

This is simply wrong. The effect of Ibuprofen as stated in their paper is minimal, in contrast to acetazolamide which is substantial.

Something that doesn't work is NOT an appealing alternative to something that ACTUALLY works!

Full article:

http://www.annemergmed.com/webfiles/images/journals/ymem/FA-gslipman.pdf

Re: Ibuprofen & AMS
Ken #22144 03/22/12 07:09 AM
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As I speculated above, and Ken confirmed, I think they need to do better research on these alternatives. This study is surprisingly sloppy coming from Stanford and UCSD.

Gingko Biloba keeps looking like a possible contender. I used it one time on Shasta, but I've never had AMS very bad anyway. Here are links to some studies on the reported benefits of using Gingko Biloba to prevent AMS. Again, small number of subjects involved to make statistical comparisons, and nothing works for everyone.

The first study used 12 subjects in 3 groups, Gingko, Diamox, and Placebo in Northern Chile. Treatment started 1 day in advance, which is a short window for the Gingko to take effect. The group taking the Gingko apparently did the best of the three.

Gingko Biloba 1-day prior to ascent

A second link is an article that reports on a study on Pike's Peak where 40 students took either Gingko or Placebo 5 days in advance. 7/20 got AMS with Gingko vs 13/19 without, and the severity was less with Gingko.

Pike's Peak Students on Gingko Biloba

The study was conducted by Dr. Peter Hackett, who's got lots of experience on Mt Everest and is a regular contributor to the website (Everestnews.com). He also refers to a French study on Gingko. He wrote,

"I would especially recommend it [Gingko Biloba] for those situations in which I might consider Diamox: abrupt ascent, past history of AMS, and those who really need to avoid AMS for various reasons, like diabetes, lung disease, maybe pregnancy, etc. If it didn't work, and Diamox was felt necessary, no problem, you could give Diamox." Dr. Peter Hackett, MD

Gingko increases blood flow which helps circulation. Those taking Gingko [in the French study] reported significantly warmer hands and feet, according to Dr. Hackett.

Gingko has been shown to be helpful for those with dementia also. Did I mention it might help with dementia? It can also help with dementia, but they need more study. Some studies say it might help with dementia. I think I'll take some right now...

Re: Ibuprofen & AMS
SierraNevada #22147 03/22/12 09:40 AM
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> Gingko Biloba keeps looking like a possible contender.

Regarding the Gingko recommendations, I see there are lots of sites on the Internet recommending it for AMS, even more now than a few years ago. However, there were initial studies showing it had a beneficial effect, but then followups with more people and better controls, that found no effect.

I haven't looked for any recent studies, so if anyone can find them, please do give some links.

But the ISMM International Society for Mountain Medicine paper "An Altitude Tutorial" states:
Quote:
Ginkgo biloba extract
Some early work with Ginkgo biloba extract was encouraging with regards to its use in preventing AMS, but some recent large, well-designed studies have shown no benefit.

Re: Ibuprofen & AMS
Steve C #22155 03/22/12 08:09 PM
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Originally Posted By: Steve C
> I haven't looked for any recent studies, so if anyone can find them, please do give some links.

I Googled a little deeper into the Gingko studies out there. There are conflicting studies. Again, I think its due to the small sample size in most of these studies. One study claims that the differences in results are due to differences in the source of the Gingko. Standardization of dosage and ingredients is one of the troubles with herbal solutions.

Besides the two studies mentioned in my post above, the French did a 3rd study which also showed benefit using Gingko, but again, a small number of people. I can't find a link to the actual study, just reports of the study (maybe it was never translated).

The only study I've found with a large sample size of people was on Mt Everest, reported in the British Medical Journal. This one showed no benefit to taking Gingko. The study used results from 487 people but the ascent circumstances were very different than climbing Mt Whitney. The people came from the airport at 9,200 ft and hiked up to 14,300 ft where the study began. So basically, the participants were already at about the same elevation as Whitney to start. From there, they took Gingko or Diamox or placebo and then climbed up to 16,200 ft and were checked for AMS. Not only did the Ginkgo not help under these circumstances, the group that combined Gingko with Diamox did slightly worse than the Diamox only group. The study notes, "these results may not be generalisable to other high altitude trekking environments where ascent rates and baseline elevation or final elevation may be different."

The one thing that all the studies have in common is that Diamox consistently works for many people. I plan to try it for the first time on Shasta this spring.


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