What to tell us, and what to ask a doctor, before trekking with a medical condition
Asthma, heart conditions, diabetes, pregnancy, a replaced joint. None of these is an automatic no, but each changes the route, and one of them changes the insurance.
By the Lakeshore team · 6 min read · Updated 5 October 2026
People often don't mention a condition because they're afraid we'll say no. Then we plan the wrong trip and find out at 3,500 m.
If you tell us, we plan around it. Usually there's a route that works. Occasionally there isn't, and it's much better to find that out in an email than on a ridge.
None of this is medical advice. It covers what we need to know from you, and what to take to a doctor who understands altitude.
What altitude does, briefly
Above about 2,500 m, each breath brings in less and less oxygen. A healthy body makes up for it by breathing faster and deeper and, over days, through changes in the blood. Acclimatisation days are there to give that adaptation time.
Any condition that already limits how oxygen is delivered, whether by the lungs, the heart or the blood, makes that harder. So does any condition affected by dehydration, cold, exertion or broken sleep, because trekking involves all four. Everything below follows from that one idea.
Common conditions and what usually happens
Asthma. Often fine on the standard routes if you carry your medication and a spare inhaler. Cold, dry air and dust are triggers, so pace and layers matter. Tell your guide where the inhaler is.
Heart conditions. You need a cardiologist's opinion on altitude and exertion specifically. A general fitness sign-off isn't enough. Low routes below 2,000 m, such as the Royal Trek, Ghandruk and the Pokhara day walks, are a different proposition from anything above 3,500 m.
Diabetes. Manageable with planning. Cold affects how you store insulin, exertion changes how much you need, and lodge meals are heavy on carbohydrate and come at unpredictable times. Bring more supplies than the trip needs and keep them in your daypack, not in the porter's load.
Replaced joints and arthritis. Going downhill is the problem, not altitude. Poles, shorter days and a porter make a big difference. Ask your surgeon specifically about long stretches of downhill walking.
Pregnancy. Medical guidance generally advises against sleeping at significant altitude, and the sensible reading is to stay low. Pokhara day walks, Bandipur, Chitwan and boats make a lovely trip without going high. Ask your own doctor and tell us what they say.
The insurance clause that catches people
Undeclared pre-existing conditions are the second most common reason a claim is refused in Nepal, after the altitude cap.
Declare everything, including things you think of as historic or under control. The premium may go up, but a refused claim after a helicopter evacuation costs several thousand dollars.
Some policies also lower the altitude limit or exclude trekking above a certain age. Read that clause yourself instead of assuming.
What we do with the information
We choose a route with the right maximum altitude and the right descent profile. That usually means a different trek, and only occasionally the same one done more slowly.
We build in shorter days, add nights, and pick lodges that are easier to reach and have warmer rooms.
We brief your guide, in confidence, on what to watch for and where your medication is. Guides carry a first-aid kit and do daily oximeter checks, but they aren't clinicians, and knowing your specifics is what makes them useful.
And once in a while we advise against the trip you asked for and suggest another. That conversation has never cost us a client who was glad to be told afterwards.
Walk it with us
Private departures on your dates, guided by the people who wrote this page.
Questions we get asked
Will you refuse to take me?
Rarely, and only where the risk is serious and changing the route can't manage it. Far more often we suggest a different trek. We'd rather lose the booking than be four days up a valley with a problem we could have foreseen.
Is my information kept private?
Yes. It goes to the person planning your trip and, as a short summary of what's relevant, to your guide. Nowhere else.
Can I trek at altitude with high blood pressure?
Often, with medication and monitoring, but ask your doctor about your own case. Altitude can raise blood pressure, so bring a plan from them.
What if a condition develops after I book?
Tell us. We can usually change the route, and it's far easier before the permits are issued.
Are there routes with road access throughout?
The Royal Trek and Ghandruk both stay close to a road for most of their length, and the Pokhara day walks are all within an hour of a hospital. Being that close is a legitimate part of planning. We run both treks with private transport at each end.
Still deciding?
Tell us your dates, and we'll tell you whether Permits & TIMS Service is right for you. If it isn't, we'll say so.
Nothing to pay online. We confirm your dates first.
Or call the office +977 61-457830