Altitude After-Effects: Long-Term Recovery and What Happens to Your Body

You are back at sea level. Your trek is over. You expected to feel fantastic -- you just accomplished something extraordinary. Instead, you feel exhausted, disoriented, unable to sleep properly, and strangely emotional. Your appetite is either insatiable or absent. You have lost noticeable weight. Your cough will not go away. You are irritable at work and find yourself daydreaming about the mountains.

Welcome to the world of altitude after-effects.

Most trekkers prepare extensively for going to altitude -- they read about acclimatization, learn to recognize HAPE and HACE, and carry Diamox as insurance. But almost nobody prepares for what happens after altitude. Your body has undergone significant physiological changes during your time at elevation, and it does not simply snap back to normal the moment you descend.

This guide covers the complete picture of post-altitude recovery: what happens to your body at the cellular level, the common symptoms you will experience, the psychological effects that catch many trekkers off guard, when your symptoms are normal versus when they warrant medical attention, and a detailed timeline for returning to exercise and normal life.

For general post-trek recovery covering nutrition, massage, and practical recovery steps, see our post-trek recovery guide.

What Altitude Does to Your Body

To understand the after-effects, you need to understand what your body did to adapt to altitude in the first place. When you trek above 2,500 meters, your body initiates a cascade of physiological changes:

Red Blood Cell Production

At altitude, your kidneys detect lower oxygen levels and release erythropoietin (EPO), which stimulates your bone marrow to produce more red blood cells. Over 2-3 weeks at altitude, your red blood cell count can increase by 20-30%. This is the same mechanism that drives altitude training camps for elite athletes.

After descent: Your body now has significantly more red blood cells than it needs at sea level. The excess cells are gradually broken down by the spleen and liver over 4-6 weeks. During this period, you may notice:

• Dark urine (from hemoglobin breakdown products)
• Mild fatigue as the rebalancing occurs
• A temporary performance boost for aerobic activities (the "altitude advantage" that athletes seek)

Breathing Pattern Changes

At altitude, you breathe faster and deeper to compensate for lower oxygen. Your respiratory center recalibrates to this increased ventilation rate.

After descent: Your breathing center needs time to readjust. You may experience:

• Sighing or taking deep breaths involuntarily
• Feeling like you are not getting enough air (despite having more oxygen than you need)
• Periodic breathing during sleep for the first few nights
• The lingering "Khumbu cough" from irritated airways

Cardiovascular Adjustments

At altitude, your heart rate increases, blood pressure changes, and blood vessels in the lungs constrict (hypoxic pulmonary vasoconstriction). Your heart has been working harder than normal for the entire trek.

After descent: Your cardiovascular system gradually returns to baseline:

• Resting heart rate normalizes within 3-7 days
• Blood pressure may fluctuate for 1-2 weeks
• Exercise heart rate may be lower than normal for 2-4 weeks (due to increased oxygen-carrying capacity)

Metabolic Changes

At altitude, your basal metabolic rate increases by 10-20%. Combined with the physical demands of trekking, your body has been burning significantly more calories than normal while receiving fewer calories than ideal.

After descent: Your metabolism remains elevated for several days before returning to normal:

• Increased hunger (your body is trying to replenish depleted energy stores)
• Rapid initial weight regain (mostly water and glycogen, not fat)
• Gradual muscle mass recovery over 2-4 weeks with proper nutrition

Hormonal Shifts

Altitude triggers changes in multiple hormone systems: increased cortisol (stress hormone), altered thyroid function, changes in appetite-regulating hormones (leptin and ghrelin), and shifts in testosterone and estrogen levels.

After descent: These hormonal shifts can cause:

• Mood swings and irritability
• Altered menstrual cycles in women (delayed or irregular periods are common)
• Decreased libido
• Sleep disruption (cortisol affects sleep-wake cycles)
• Emotional sensitivity

Common Post-Altitude Symptoms

Persistent Fatigue

What you experience: Crushing tiredness that seems disproportionate to your activity level. You may sleep 10-12 hours and still feel exhausted. Simple daily tasks feel draining.

Why it happens: Your body is simultaneously recovering from the physical demands of the trek, readjusting its red blood cell count, rebalancing hormones, and rebuilding depleted energy stores. This is an enormous amount of physiological work happening behind the scenes.

Timeline: Most significant in the first week. Gradually improves over 2-3 weeks. If severe fatigue persists beyond 4 weeks, see a doctor.

Management:

• Accept the fatigue and rest. Do not fight it.
• Sleep as much as your body wants.
• Eat nutrient-dense meals with adequate protein and complex carbohydrates.
• Stay hydrated (3-4 liters per day).
• Light walking is fine; avoid intense exercise.

Sleep Disruption

What you experience: Difficulty falling asleep, waking frequently during the night, vivid dreams, feeling unrested despite long sleep.

Why it happens: At altitude, your breathing pattern changes to compensate for low oxygen. Your brain's respiratory center, which controls breathing during sleep, needs time to recalibrate to sea-level oxygen levels. Additionally, elevated cortisol levels from the trek disrupt normal sleep architecture.

Timeline: Most pronounced in the first 5-7 days. Sleep patterns typically normalize within 10-14 days.

Management:

• Maintain consistent sleep and wake times (even if you lie awake initially)
• Avoid caffeine after noon
• Keep your room cool, dark, and quiet
• Avoid screens for an hour before bed
• Melatonin (1-3 mg) may help during the first week -- consult a pharmacist
• Do not use alcohol as a sleep aid (it worsens sleep quality)

Appetite Changes

What you experience: Either ravenous hunger (your body demanding caloric replenishment) or continued appetite suppression (altitude can suppress appetite hormones, and this effect lingers).

Why it happens: Altitude suppresses ghrelin (the hunger hormone) and disrupts normal appetite signaling. After descent, these signals take time to recalibrate. Simultaneously, your body has a significant caloric deficit to repair.

Timeline: Appetite typically normalizes within 5-10 days. Intense hunger may persist for 2-3 weeks as your body rebuilds.

Management:

• If hungry: Eat. Your body needs fuel. Focus on protein, healthy fats, and complex carbohydrates.
• If appetite is suppressed: Eat small, frequent meals even if you do not feel hungry. Your body still needs nutrition for recovery.
• Cravings for specific foods (especially high-calorie foods, sweets, and protein) are your body telling you what it needs.

Weight Loss

What you experience: You have lost noticeable weight -- typically 3-8% of body weight on treks longer than 10 days. Your clothes are looser, and you look thinner, especially in the face and legs.

Why it happens: Extended trekking at altitude creates a sustained caloric deficit. At elevations above 5,000 meters, the body begins breaking down muscle protein for energy even when food is available. Glycogen stores are depleted, and with them, the water weight they hold.

Weight loss breakdown:

| Component | Percentage of Total Loss | Recovery Time | |-----------|------------------------|---------------| | Water and glycogen | 30-40% | 3-5 days | | Fat mass | 30-40% | 2-4 weeks | | Muscle mass | 20-30% | 3-6 weeks |

Management:

• Expect rapid initial weight gain (2-3 kg) in the first week as glycogen and water are replenished
• Muscle mass recovery requires adequate protein intake (1.6-2.0 grams per kilogram of body weight per day)
• Do not attempt caloric restriction or dieting during the recovery period
• Resistance training can begin after 2 weeks to help rebuild muscle

The Khumbu Cough

What you experience: A persistent, dry, hacking cough that may have started during the trek and continues after descent. It can be severe enough to cause rib soreness, interrupt sleep, and embarrass you in quiet settings.

Why it happens: The dry, cold air at altitude (humidity drops below 10% above 4,000 meters) causes significant irritation and drying of the respiratory mucosa. Combined with increased breathing volume, dust exposure on trails, and possible mild airway inflammation from the cold, the airways become chronically irritated.

Timeline: Typically resolves within 1-3 weeks after returning to lower altitude and more humid air. If the cough persists beyond 3 weeks, is productive (producing colored sputum), or is accompanied by fever, see a doctor.

Management:

• Honey in warm water or tea (evidence-based cough suppressant)
• Throat lozenges
• Stay in environments with adequate humidity (avoid air conditioning)
• Stay hydrated
• Avoid dusty environments (Kathmandu's air quality can prolong the cough)
• Over-the-counter cough suppressants (dextromethorphan) for nighttime relief if needed

When Symptoms Are Normal vs. When to See a Doctor

This is the critical question that causes the most anxiety for returning trekkers. Here is a clear framework:

Normal Post-Altitude Symptoms (No Doctor Needed)

| Symptom | Normal Duration | Notes | |---------|----------------|-------| | General fatigue | Up to 3 weeks | Should gradually improve | | Muscle soreness | 5-10 days | Worst in first 3 days | | Dry cough | 1-3 weeks | No fever, clear if productive | | Sleep disruption | 5-14 days | Gradually improving | | Weight loss | Recovery in 2-4 weeks | With proper nutrition | | Mild headaches | 1-3 days after descent | Resolving | | Increased urination | 3-5 days | Body clearing excess fluid | | Mild swelling (hands/feet) | 2-5 days | Resolving | | Irregular menstrual cycle | 1-2 cycles | Returns to normal | | Mood swings/irritability | 1-3 weeks | Gradually improving | | Vivid dreams | 1-2 weeks | Normal sleep adjustment |

Warning Signs (See a Doctor)

Where to Seek Medical Help

In Kathmandu:

• CIWEC Travel Medicine Clinic (Lazimpat): Nepal's premier travel medicine clinic, staffed by Western-trained doctors with extensive altitude medicine experience. Most international insurance accepted. This should be your first choice.
• Nepal International Clinic (Lal Durbar): Another excellent option with experienced doctors.

In Pokhara:

• Western Regional Hospital: Government hospital with basic services
• Manipal Teaching Hospital: Better-equipped facility with English-speaking doctors

After returning home:

• See your primary care doctor and mention your high-altitude trek specifically. Request a complete blood count and basic metabolic panel if symptoms persist beyond 3 weeks.
• If you have respiratory symptoms, a chest X-ray may be appropriate.
• A stool test is recommended if you have persistent digestive issues (to check for Giardia and other parasites).

Re-Entry to Exercise: A Detailed Timeline

One of the most common questions trekkers ask is: "When can I run/gym/play sports again?" The answer depends on the duration and intensity of your trek.

Week 1: Active Recovery Only

What to do:

• Walking (flat terrain, 20-40 minutes)
• Very gentle stretching
• Restorative yoga
• Swimming (gentle laps, not training)

What to avoid:

• Running or jogging
• Weight training
• High-intensity interval training (HIIT)
• Contact sports
• Competitive sports

Why: Your muscles are still in the acute recovery phase. Tendons and ligaments have been stressed by uneven terrain and need recovery time. Your immune system is temporarily suppressed, and intense exercise would further compromise it.

Week 2: Light Exercise Returns

What to do:

• Light jogging (15-20 minutes at easy pace)
• Bodyweight exercises (squats, lunges, push-ups -- moderate volume)
• Cycling at easy pace (30-45 minutes)
• Yoga (all styles except power/intense)
• Light hiking on even terrain

What to avoid:

• Heavy weightlifting
• Speed work or intervals
• Long runs (beyond 30 minutes)
• Anything that causes joint pain

Why: Your muscles are rebuilding, but tendons and ligaments recover more slowly. Your cardiovascular fitness is actually temporarily enhanced (altitude effect), which can trick you into thinking you are more recovered than you are.

Week 3: Moderate Exercise

What to do:

• Running (30-45 minutes at moderate pace)
• Weight training (moderate loads, 60-70% of pre-trek max)
• Full yoga practice
• Cycling, swimming, rowing at moderate intensity
• Hiking with moderate elevation gain

What to avoid:

• Maximum effort lifts
• Race-pace running
• Ultra-long endurance sessions
• Plyometrics and explosive movements

Week 4 and Beyond: Return to Full Activity

What to do:

• Gradually return to pre-trek training volume and intensity
• Increase loads and distances by no more than 10-15% per week
• Resume competitive sports and racing

Monitoring: If you experience any of the following during exercise, back off and rest:

• Joint pain (especially knees) that persists after exercise
• Unusual fatigue after workouts that previously felt easy
• Elevated resting heart rate (more than 10 beats above your normal baseline)
• Persistent muscle soreness that does not resolve between sessions

Return-to-Exercise Timeline by Trek Type

| Trek Type | Duration | Return to Light Exercise | Return to Full Training | |-----------|----------|------------------------|------------------------| | Short trek (Poon Hill, 4-5 days) | Low altitude, short | 3-5 days | 10-14 days | | Medium trek (ABC, 10-12 days) | Moderate altitude | 5-7 days | 2-3 weeks | | Long trek (EBC, 14 days) | High altitude | 7-10 days | 3-4 weeks | | Extended trek (Annapurna Circuit, 18-21 days) | High altitude, long | 10-14 days | 4-6 weeks | | Extreme trek (Three Passes, 21+ days) | Very high altitude | 14+ days | 6+ weeks |

Psychological Effects: The Post-Trek Adjustment

The physical recovery is well-documented, but the psychological after-effects of a major trek often catch people completely off guard. These are real, common, and worth understanding.

Post-Trek Blues

What it feels like: A sense of deflation, sadness, or emptiness after returning from the mountains. You miss the simplicity of trail life, the camaraderie, the daily purpose, and the raw beauty of the Himalayan landscape. Normal life feels mundane, repetitive, and meaningless by comparison. You may feel disconnected from friends and family who "do not understand" what you experienced.

Why it happens:

• Contrast effect: Trail life is intense, focused, and aesthetically overwhelming. Returning to an office, commute, and routine creates a stark contrast.
• Community loss: On the trail, you were part of a community -- fellow trekkers, guides, porters, tea house owners. This instant community dissolves the moment you get on a plane.
• Purpose loss: On the trail, your purpose was clear and physical -- get to the next village, reach base camp, cross the pass. In normal life, purpose is more abstract and less immediately satisfying.
• Hormonal rebalancing: Cortisol and endorphin levels, elevated during the trek, are normalizing. This creates a physiological "comedown" similar to post-event letdown in athletes.
• Sensory withdrawal: The stunning visual landscape of the Himalayas creates a sensory baseline that makes normal environments feel dull.

Management:

• Acknowledge the feeling. It is normal and shared by the majority of returning trekkers. You are not ungrateful or dramatic -- this is a real psychological phenomenon.
• Process the experience: Write about your trek, organize your photos, create a trip report. The act of processing solidifies the experience and helps integrate it. See our guide to writing and sharing your trek experience.
• Connect with fellow trekkers: The trekking community online is active and supportive. Sharing stories with people who understand the experience helps.
• Plan your next adventure: Having something to look forward to is one of the most effective treatments. Start researching your next Nepal trek or another adventure.
• Maintain physical activity: Exercise releases endorphins and provides the physical challenge your body has become accustomed to.
• Give it time: Post-trek blues typically peak around days 5-10 home and resolve within 2-4 weeks.

Altitude Addiction

What it feels like: An intense, almost compulsive desire to return to the mountains. You find yourself constantly looking at trek photos, researching new routes, daydreaming about Nepal, and feeling that your "real life" is actually up there in the mountains.

Why it happens: The combination of physical challenge, extreme beauty, endorphin release, flow state experiences, and the sense of accomplishment creates a powerful positive reinforcement loop. The simplicity and clarity of mountain life, where survival needs are primary and distractions are absent, can feel more authentic than complex modern life.

Is it a problem? Not inherently. Many people build beautiful lives around mountain culture, becoming guides, writers, photographers, or simply regular trekkers who return annually. It becomes problematic only if it leads to neglecting responsibilities, relationships, or financial stability.

Management: Channel the energy productively:

• Join local hiking or mountaineering clubs
• Plan and save for annual trekking trips
• Bring mountain values (simplicity, presence, physical challenge) into daily life
• Practice mindfulness and outdoor activities at home
• Read mountain literature and stay connected to the community

Reverse Culture Shock

What it feels like: Feeling alien in your own culture after the intensity of Nepal. You may be irritated by consumerism, waste, and complaints about trivial problems. The pace and values of your home environment may feel superficial compared to the simplicity and warmth you experienced in Nepal.

Why it happens: Immersion in a dramatically different culture, combined with the raw physical reality of trekking, shifts your perspective. Nepal -- despite its poverty and challenges -- can feel more "real" than comfortable Western life.

Management:

• This feeling is common among all international travelers, amplified by the intensity of a trekking experience
• It typically fades within 2-4 weeks as you readjust
• Use the perspective shift productively -- simplify aspects of your life that genuinely do not serve you
• Avoid being preachy about your experience to friends and family (they will tune out quickly)
• Find ways to maintain connection with Nepali culture and people

Long-Term Effects of Altitude Exposure

For most trekkers, altitude exposure during a single trek has no lasting negative health effects. However, understanding the long-term implications is valuable, especially for those who trek repeatedly.

Positive Long-Term Effects

• Improved cardiovascular efficiency: Repeated altitude exposure can have lasting positive effects on heart and lung function
• Enhanced stress resilience: The physical and mental challenge of trekking builds general stress tolerance
• Better altitude acclimatization for future trips: Your body "remembers" altitude to some degree, and subsequent trips often involve fewer symptoms
• Mental health benefits: Regular exposure to natural environments and physical challenge is consistently linked to lower rates of depression and anxiety

Neutral Long-Term Effects

• Red blood cell count: Returns completely to normal within 4-6 weeks. No lasting change from a single trek.
• Lung function: No lasting changes from a single trek at typical trekking altitudes (below 6,000 meters)
• Brain function: Brief periods at trekking altitudes do not cause lasting cognitive effects

Potential Concerns for Repeated High-Altitude Exposure

These apply primarily to professional guides, Sherpa, and others who spend extended periods above 5,000 meters year after year -- not to occasional trekkers:

• Chronic mountain sickness (Monge's disease): A condition affecting long-term altitude residents, characterized by excessive red blood cell production, fatigue, and cognitive impairment. This does not develop from occasional trekking.
• Pulmonary hypertension: Repeated or prolonged altitude exposure can cause lasting changes in pulmonary blood vessels. This is primarily a concern for people living permanently at very high altitudes.
• Retinal changes: Extremely high altitude exposure (above 7,000 meters) can cause retinal hemorrhages. At typical trekking altitudes, this is not a concern.

Special Populations

Women Returning from Altitude

Women may experience additional post-altitude effects:

• Menstrual irregularity: Delayed, missed, or unusually heavy periods are common after altitude treks. Altitude, physical stress, caloric deficit, and weight loss all affect the menstrual cycle. Normal cycles typically resume within 1-2 months.
• Iron depletion: Women who menstruate are at higher risk of iron deficiency after altitude (the body uses iron to produce the extra red blood cells at altitude). Consider an iron supplement or iron-rich diet during recovery.
• Hormonal mood effects: Fluctuating estrogen and progesterone combined with altitude-related cortisol changes can amplify mood swings during recovery.

Older Trekkers (50+)

Older trekkers may experience:

• Extended recovery timeline: Add 30-50% to the recovery timelines listed above
• Joint recovery: Knees and hips may take longer to recover from the repetitive impact
• Cardiovascular re-adjustment: Blood pressure may take longer to normalize
• Sleep disruption: Can be more pronounced and longer-lasting

Trekkers with Pre-Existing Conditions

If you have pre-existing medical conditions, be aware of:

• Asthma: Post-altitude airway sensitivity may be increased. Monitor symptoms carefully and have your inhaler available.
• Diabetes: Blood sugar management may be disrupted for 1-2 weeks. Monitor more frequently.
• Heart conditions: Post-altitude cardiovascular changes may require monitoring. Consult your cardiologist before trekking and after returning.
• Thyroid conditions: Altitude can temporarily affect thyroid function. Recheck levels 4-6 weeks after return.

Practical Recovery Protocol: The First 30 Days

Days 1-3: Complete Rest Phase

• Sleep as much as needed (10-12 hours normal)
• Hydrate aggressively (3-4 liters per day)
• Eat nutrient-dense meals even if appetite is low
• Light walking only (20-30 minutes)
• No exercise beyond gentle movement
• Get a light massage (Swedish, not deep tissue) on day 2-3

Days 4-7: Active Recovery Phase

• Begin gentle stretching routine (15-20 minutes daily)
• Walking increases to 30-60 minutes
• Restorative yoga or gentle stretching classes
• First deep tissue massage (day 4-5)
• Continue prioritizing sleep and nutrition
• Monitor and note any persistent symptoms

Days 8-14: Gradual Return Phase

• Light jogging or cycling returns (20-30 minutes)
• Bodyweight exercises (moderate volume)
• Yoga (all gentle to moderate styles)
• Second massage session
• Most symptoms should be improving noticeably
• Address any persistent issues (doctor visit if needed)

Days 15-21: Building Phase

• Running, cycling, swimming at moderate intensity
• Weight training returns (moderate loads)
• Longer hikes or outdoor activities
• Sleep should be normalized
• Weight should be stabilizing
• Energy levels approaching normal

Days 22-30: Normalization Phase

• Return to pre-trek training intensity and volume
• Competitive sports resume
• All symptoms should be resolved or minimal
• If any significant symptoms persist, see a doctor
• Begin planning your next adventure

The Science of Altitude Re-Acclimatization

An interesting question that returning trekkers often ask is: "Will it be easier next time?" The answer is nuanced.

What the Research Shows

• Short-term memory: If you return to altitude within 2-8 months of your last exposure, you may acclimatize slightly faster. Your body retains some "physiological memory" of the adaptations.
• Long-term benefit: After more than a year, most altitude-specific adaptations have fully reversed. However, the psychological benefit of knowing what to expect persists.
• Individual variation: Some people acclimatize easily every time; others struggle regardless of experience. Genetic factors play a significant role.
• Fitness is not acclimatization: Being physically fit does not guarantee good acclimatization, but it does mean you have more physiological reserve if you do get mild altitude sickness.

Implications for Planning Your Next Trek

• If you are planning another high-altitude trek within 6-12 months, you may benefit from slightly retained acclimatization
• Do not assume previous successful acclimatization guarantees future success -- always follow proper acclimatization protocols
• Consider progressively challenging treks: if you did EBC (5,364m), you have a good foundation for other treks at similar or slightly higher altitudes
• Read our guide on planning your second Nepal trek for comprehensive advice

Frequently Asked Questions

How long until I feel completely normal after my trek?

For most trekkers who completed a 10-14 day trek at moderate to high altitude, full physical and psychological normalization takes 2-4 weeks. Shorter, lower-altitude treks (Poon Hill, Mardi Himal) may recover in 1-2 weeks. Longer, higher treks (Annapurna Circuit, Three Passes) can take 4-6 weeks for complete recovery.

Is it normal to feel depressed after a trek?

Yes, this is extremely common and has a name: post-trek blues or post-adventure depression. The combination of returning from an intense, beautiful, purposeful experience to normal routine life, combined with hormonal rebalancing and physical fatigue, creates a genuine low mood that most trekkers experience. It typically resolves within 2-4 weeks. If it persists beyond 6 weeks or intensifies, consider speaking with a professional.

When can I start running again after my trek?

Light jogging can resume in the second week post-trek (days 8-14). Start with 15-20 minutes at easy pace on flat terrain. By week 3, you can extend to 30-45 minutes at moderate pace. Full training volume and intensity should wait until week 4. If you have knee pain, delay running until the pain has resolved.

Is the persistent cough after my trek something to worry about?

The Khumbu cough (post-altitude dry cough) is extremely common and almost always benign. It is caused by airway irritation from breathing cold, dry, dusty air at altitude. It typically resolves within 1-3 weeks. See a doctor if: it persists beyond 3 weeks, produces colored sputum (green, yellow, or bloody), is accompanied by fever, or includes chest pain or shortness of breath.

Why did I lose so much weight on the trek?

Weight loss during Nepal treks occurs because caloric expenditure significantly exceeds caloric intake. At altitude, you burn 3,000-5,000 calories per day while eating less due to altitude-related appetite suppression and limited food options. Above 5,000 meters, your body also breaks down muscle protein for energy. Weight loss of 3-8% of body weight is normal for treks longer than 10 days.

Will the altitude make my next trek easier?

Partially. If you return to altitude within 6-12 months, you may retain some acclimatization benefit. More importantly, the psychological benefit of knowing what to expect is significant. However, never assume you are immune to altitude sickness based on previous experience -- always follow proper acclimatization schedules. Your previous success does not guarantee future success.

Is it normal for my period to be late after trekking?

Yes. Menstrual irregularity (delayed, missed, or unusually heavy periods) is common after high-altitude treks. Physical stress, caloric deficit, weight loss, and altitude-related hormonal changes all affect the menstrual cycle. Normal cycles typically resume within 1-2 months. If irregularity persists beyond 3 months, consult a doctor.

Should I take supplements during recovery?

A balanced diet is the best recovery strategy. However, some supplements may be beneficial: iron (especially for women), vitamin C (supports immune recovery), vitamin D (especially if returning to a low-sunlight environment), omega-3 fatty acids (anti-inflammatory), and a quality multivitamin to cover any gaps. Protein supplements can help with muscle recovery if dietary protein is insufficient. Always consult a healthcare provider before starting supplements.

Can altitude trekking cause long-term brain damage?

At typical trekking altitudes (below 6,000 meters) with proper acclimatization, there is no evidence of lasting brain damage from a single trek. Brief cognitive effects (forgetfulness, difficulty concentrating) in the days after a trek are normal and transient. Long-term neurological effects are associated with extreme altitude (above 7,000 meters), prolonged exposure, or acute altitude illness (HACE) that was not treated promptly.

Why do I keep dreaming about the mountains?

Vivid dreams about your trek experience are common for weeks after returning. This is your brain's way of processing the intense experiences -- the physical exertion, the visual landscape, the emotional peaks, and the novel environment. It is a sign of healthy memory consolidation, not a disorder. Many trekkers report that mountain dreams continue intermittently for months or even years.

Is it normal to feel angry or frustrated when I get back to normal life?

Yes. Reverse culture shock and post-adventure frustration are well-documented phenomena. After the simplicity and beauty of mountain life, normal life can feel cluttered, wasteful, and pointless. Traffic, work politics, consumer culture, and trivial complaints can trigger disproportionate irritation. This typically fades over 2-4 weeks. Use the perspective shift constructively -- simplify where you can -- but avoid alienating friends and family with constant comparisons to your trek experience.

When should I fly after returning from high altitude?

You can fly home after returning to Kathmandu (1,400 meters), as airplane cabins are pressurized to approximately 1,800-2,400 meters equivalent altitude. However, we recommend at least 2 full rest days in Kathmandu before a long international flight. If you experienced any altitude illness during your trek, wait longer and consult a doctor before flying. Mild swelling in hands and feet is common during post-trek flights -- move around periodically and stay hydrated.