Xenon Gas and High-Altitude Performance with Dr. Peter Hackett

00:05.27
Steve
Today’s guest is a true legend in both the world of high altitude medicine and mountaineering. Dr. Peter Hackett is a board certified emergency physician, a pioneering researcher, and someone whose work has shaped how we understand and treat the effects of high altitude on the human body.

00:21.71
Steve
Peter was part of the American Medical Research Expedition to Everest in 1981 and became the 111th person. Is that correct, Peter? 111? person is that correct peter one hundred and eleven

00:30.92
Peter
That’s right. Okay.

00:32.11
Steve
person to summit Everest solo from the South col, no less. And over the past four decades, Peter has dedicated his career to studying altitude illness and human performance in extreme environments.

00:43.36
Steve
He has published over 100 papers in peer-reviewed journals and founded the Institute for Altitude Medicine based in Telluride, Colorado. Peter has treated climbers on Denali, on Everest, on Aconcagua, and when he’s not away on an expedition, he may be found backstage at a Rolling Stones concert serving as the band’s tour doctor.

01:05.47
Steve
From the summit of Everest to the front row of rock and roll, Peter has probably seen it all. And you may not remember this, Peter, but you were the lead instructor on the first Wilderness First Responder course I took, I think it was 1991 in Yosemite Valley.

01:24.10
Steve
AMGA organized the course and, you know, learning from you but from the first time about high altitude was a dream for me as a young 20-year-old mountain guide at that time, aspiring mountain guide.

01:24.60
Peter
All right.

01:40.35
Steve
So welcome to the show, Peter. Thank you for being here.

01:43.30
Peter
Thanks, Great to be here.

01:47.80
Steve
So today I want to talk about Xeon, a particular subject. And we’re bringing you on, obviously, for your breadth of experience, but also you have this really unique perspective as a mountaineer, as a medical doctor, as a researcher, specifically around the effects of high-altitude and high-altitude illnesses.

02:16.50
Steve
And One of the things I want to help people understand is just what Xenon is. So while I definitely want to hear a story about touring with the stones, let’s start from the top.

02:27.67
Steve
What exactly is Xenon gas and how does it interact with the body on a physiological level?

02:30.20
Peter
Thank you.

02:33.59
Steve
What do we know?

02:36.05
Peter
Yeah, good place to start. You know, xenon is one of the noble gases. It’s a part of the atmosphere. It’s a very rare atmospheric gas. About one in 10 million parts of the atmosphere is made up by xenon as opposed to, you know, the other noble gases are argon and krypton and helium and are even more common than that.

03:02.77
Peter
The noble gases are thought not to be chemically reactive. They’re considered to be inert, which is interesting. But they do have physiological effects, so they seem to act on molecules, especially certain receptors in the body.

03:24.10
Peter
And, you know, xenon, it was discovered in 1898, it was purified from liquefied air, and it was used initially as an anesthetic agent.

03:37.50
Peter
It is still an anesthetic agent. It’s used to promote, and well, to provide anesthesia in Russia quite a bit. The Russians have quite a bit of experience with it. It was used in the U.S. in the 30s and 40s, and it’s very similar to nitrous oxide.

03:53.10
Peter
It has some similarities to ketamine. It has similarities to cyclopropane, which is a more common anesthetic. One of the main reasons it’s not used as an anesthetic anymore is that it’s so expensive, much, much more expensive than any of the other anesthetic gases.

04:12.53
Peter
But it’s safe when it’s used by an anesthesiologist, and it’s effective as an anesthetic. And um somewhere along the line, the Russians did some work and found that it stimulated EPO and they started, yeah they were known to, it was an open secret that they were using at the Sochi Winter Olympics in 19, what was that?

04:43.58
Peter
2014.

04:44.55
Steve
Okay.

04:45.09
Peter
And that’s when it started to percolate into other circles as a possible blood doping agent or performance-enhancing agent.

04:56.40
Steve
Interesting. So do we know when you say it’s like nitrous oxide, what does that mean? that they put me to sleep if I breathe it.

05:05.44
Peter
Yes, absolutely.

05:06.92
Steve
Okay.

05:07.70
Peter
So it acts on the, well, yeah, it puts you totally out.

05:07.62
Steve
Does it, and it numbs pain.

05:13.61
Peter
um

05:14.00
Steve
Okay. Okay.

05:15.55
Peter
It acts on NMDA receptors of the brain, which is little different from some of the other anesthetics, but it’s the same receptors as nitric oxide and similar to ketamine.

05:22.40
Steve
Oh.

05:25.80
Steve
Okay.

05:27.72
Peter
So any of these agents, you know, so they’re obviously dose-related. Uh, and the Russians used it mainly.

05:33.01
Steve
Okay. Okay.

05:35.15
Peter
did they give a high enough dose, like maybe 50% or 70% Xenon gas in air or oxygen. It’s enough to put you out for surgery for a long time.

05:47.23
Peter
And then they take the gas away and you wake up. So the effect is fairly temporary.

05:50.75
Steve
okay

05:53.77
Peter
It stays in the body. You can find traces of it in the body for about three hours.

06:00.34
Steve
Okay. Interesting. And so the xenon oxygen mixture is administered through the whole surgery in the case of it’s used as a surgical anesthetic, and then it’s just basically removed.

06:13.73
Steve
And then the patient presumably just for use like pure oxygen or normal air, during recovery and they just wake up.

06:21.51
Peter
Exactly. Exactly.

06:23.64
Steve
Okay.

06:24.07
Peter
Yeah.

06:24.85
Steve
You mentioned EPO. What exactly is EPO for those of us that may not know what that term refers to?

06:31.57
Peter
Well, you know, EPO is erythropoietin. It’s the hormone made mostly by the kidney in response to low oxygen in the body. And it acts on the bone marrow and to produce more red blood cells, which is a process that takes a while. I mean, it starts in a couple hours, but you really don’t get an appreciable increase in red blood cells that will help your anemia or improve your performance for weeks.

07:02.15
Peter
And as you and well know, and as mountaineers and anybody in sports knows,

07:01.98
Steve
Mm-hmm. Mm-hmm.

07:08.74
Peter
Ah Synthetic Epo was developed for people with kidney disease who were anemic and it’s been used by athletes to increase the red blood, red blood cell count, or I like to say increase their hemoglobin in order to perform.

07:24.74
Peter
But here’s a key point that most, a lot of mountaineers don’t understand both blood doping infusion of blood ah yeah you know in preparation for a performance or you know naturally by i mean naturally injecting blood or using the synthetic hormone ah is only good at high altitude, it’s only of benefit up to about 4,000 meters.

07:53.37
Steve
Why is that?

07:55.45
Peter
It’s because after 4,000 meters, What’s much more important than the amount of hemoglobin you have in your blood is the amount of oxygen that’s loaded on that hemoglobin.

08:07.09
Peter
Breathing is much more critical. Your blood oxygen level is much more critical than your hemoglobin level. And this has been shown experimentally in and in the field.

08:21.00
Peter
And, you know, the Extreme Everest group that climbed Everest and did research after we did TNC, very nicely showed that at a certain point, the amount of hemoglobin isn’t so important and the amount of oxygen is.

08:38.04
Peter
So it’s a misperception that, I mean, if you use hypoxic tents, for example, to acclimatize, yes. You’ll raise your hemoglobin level, and it’ll definitely help on the way into base camp.

08:50.80
Peter
But it’s not to help much above base camp. And what’s more important is the other changes that take place with repeated hypoxic exposure, particularly the increase in and breathing.

09:02.45
Peter
And I think of love there’s a big misunderstanding that it’s the red cells that are all important. It’s not.

09:09.35
Steve
Yeah.

09:09.56
Peter
In fact, you can probably climb Everest with moderate anemia and probably do okay as long as you have a high enough oxygen level, oxygen saturation level.

09:20.80
Steve
Yeah, interesting. And I think a lot of the press around the use of xenon for, as a pre-acclimatization shortcut, acclimatization shortcut has focused on its known,

09:36.66
Steve
or and and maybe, maybe again, maybe I don’t, maybe this isn’t known, maybe I don’t understand the physiology of xenon well enough, you know, it acts as a stimuli to the process.

09:50.11
Steve
As you say, it’s ah it’s a four to six week process, right? From the stimuli to a mature red blood cell. And so that’s obviously a very long time. But there it seems that if this is really working the way people have been saying that it’s working for them in some individual cases, specifically with Lucas Fortenbach, and I’m going to have him on in a separate episode and explore that with him, that there must be something else going on.

10:18.91
Steve
It’s not just, it’s the red blood cell sort of a red herring. It feels like the red blood cell count isn’t the thing. There’s got to be something else to do with the oxygen saturation of the existing blood. Like you just said, you could be mildly anemic and have low red blood cell count. And if your O2 sats were good, you would be okay. I mean, that’s your, your supposition. So what else could be happening here with this gas?

10:49.96
Peter
Well, that gets, we could get into the weeds here.

10:53.84
Steve
Yeah, that’s okay.

10:55.67
Peter
First of all, let’s back up for just a minute and look at what we know about whether xenon actually increases EPO or not.

10:59.17
Steve
Okay.

11:04.80
Steve
OK. OK.

11:05.69
Peter
And, uh, that’s been shown in animals and humans, uh, that it does for a while.

11:16.49
Peter
That was established. The next thing to establish was, well, does this increase in EPO produce red blood cells and increase hemoglobin levels as synthetic EPO would or as altitude training would, you know?

11:32.69
Peter
and so the study was funded by WADA. because they became alarmed that the Russians were using xenon gas. They didn’t know if it was safe. They heard that it increased EPO.

11:48.27
Peter
Their WADA rules, that’s the World Anti-Doping Association, has banned EPO and other synthetic forms of erythropoietin as performance enhancing.

12:02.57
Peter
So WADA kind of off the cuff just banned xenon gas, but they did ah fund some research. And Justin Lawley and Ben Levine, colleagues of mine at yeah University of Texas Southwest, they did a really nice study looking at daily xenon use and intermittent xenon use in athletes and looked at EPO levels. And yes, the EPO went up.

12:29.53
Peter
But in their four-week study of using a dose of xenon every day, interestingly, there was no increase in hemoglobin or in exercise performance, which raises more questions than it does answer.

12:42.06
Steve
but

12:44.51
Peter
So they concluded that, okay, you get a little bump in EPO for a little while, but it doesn’t seem to make any difference in performance. WADA banned anyhow, is my understanding.

12:58.33
Peter
So the question remains open. And, you know, with these studies, there’s all sorts of, what dose of, of xenon are you going to use? How long are you going to use it?

13:09.35
Peter
How many times a week or month or whatever? So, you know, there’s all sorts of permutations that haven’t been studied. And, um,

13:22.67
Peter
So we’ll get back to the question.I just had to put that as ground.

13:26.79
Steve
Yeah, it’s super interesting.

13:27.11
Peter
The bottom line for you and for all climbers to know is that it’s not well established that xenon actually raises red cells.

13:38.96
Steve
Okay.

13:39.18
Peter
It’s not at all well established that it raises exercise performance. They have one study with an NF1. Well, that was Lucas Furtenbach and he studied it by himself. So, you know,

13:52.48
Peter
That’s fascinating, and I congratulate him for thinking of it and doing it, but are climbers going to adopt it based on that one experience with one person?

14:04.15
Peter
I don’t think so. We certainly wouldn’t be in any kind of medical practice, or so it needs to be studied. Now, sorry, to get back to your other question, what else could it be doing?

14:14.98
Peter
Well, there’s a researcher ah by the name of Fries in, ah I think he’s Austrian,

14:16.09
Steve
Yeah.

14:22.40
Peter
who approached Furtenbach and he had been studying xenon gas as a protective agent for the brain and other organs when circulation stops, so cardiac arrest.

14:24.84
Steve
Okay.

14:39.59
Peter
or stroke or heart attack, anything where there is no blood flow to an organ.

14:39.87
Steve
Okay.

14:46.92
Peter
And you know if this is one of the holy grails of medicine is to find an agent that can protect organs that are compromised by lack of blood flow.

14:50.69
Steve
Thank you.

14:56.86
Peter
Like in heart surgery, for example, strokes, heartache, et cetera. So ah he worked with animals and he showed that indeed Zenon, was protective if the animal had a dose of xenon, I forget just prior to, or just after the, uh, the cardiac arrest or the cessation of blood flow, it helped preserve tissue. And other researchers have shown the same in other animal models.

15:24.85
Peter
And that’s really interesting.

15:24.79
Steve
Hmm.

15:26.49
Peter
And, uh, that might turn into something to be used during heart surgeries where the heart is stopped and that sort of thing, or in strokes, I don’t know. But that’s a long way from protecting the brain from blood flow, but blood flow with low oxygen. They’re not the same.

15:46.12
Peter
and it’s a common confusion in the medical literature as well as in various communities. Stopping all blood flow and having reduced oxygen, having no oxygen is much different than having very low blood oxygen levels, but having some blood flow.

16:04.79
Peter
And all sorts of studies show you can tolerate a very low oxygen level. I mean, look, you’ve been on the 70,000 meter weeks without oxygen.

16:11.90
Steve
Yeah.

16:14.47
Peter
Your arterial PO2 is about 25 to 26.

16:19.55
Peter
And humans aren’t thought that they could survive at that level of what we call hypoxia. So um there’s a lot we don’t know.

16:26.11
Steve
Yeah.

16:29.91
Peter
And there’s a lot to learn. Whether…

16:34.13
Peter
Anyhow, he approached Furtenbach and said, you know, I found that, this is my understanding, you should talk to Lucas, but it’s my understanding that he showed him his studies, which was really good and interesting for protecting tissues that were starting oxygen.

16:48.39
Peter
And he suggested, as I understand it, that Lucas try this on the mountain. And Lucas tried and said, wow, it really made a difference. So we need to find out more about that.

16:59.42
Peter
And it hopefully will lead to some really interesting research. you know It needs to be well-funded research because it’s very expensive stuff.

17:05.41
Steve
Yeah.

17:09.84
Steve
Yeah.

17:10.08
Peter
There’s a couple of things that anybody wants to know more about or consider needs to know. One is that it’s potentially lethal, you know, just like nitrous oxide or ketamine. You give too much, you’re going to kill yourself.

17:28.55
Peter
It should be administered only by somebody who knows what they’re doing, and preferably with an anesthesia machine, with medical monitoring. And my understanding is what Lucas is going to do with his clients from the UK.

17:41.92
Peter
That’s safe.

17:42.88
Steve
here

17:44.99
Peter
That is safe. yeah You know, the original article that was published on the athletes came out, and I think the UIA statement came out and said, oh, this is really dangerous. and Well, yeah, if you were to just go online and buy a liter of Xenon and suck it in. I mean, God knows what’s going to happen.

18:03.49
Peter
So, you know, like we want to, there’s no role for that, right?

18:07.23
Steve
Right.

18:07.97
Peter
I mean, that’s potentially deadly. So you need an anesthesiologist or a skilled physician. You need a machine, you need the gas and you need medical monitoring. Okay. That’s probably the most important thing to get across.

18:20.98
Peter
The second thing,

18:21.48
Steve
And it’s probably not pure xenon, right? Because it needs to be, like you said, it’s probably 70%, 78% xenon and oxygen choked off. Okay. or or whatever whatever it is they’re still they’re they’re not going into full hypoxic.

18:32.81
Peter
Yeah,

18:35.17
Steve
getting choked off

18:36.57
Peter
That’s right. ah

18:37.81
Steve
yeah

18:38.17
Peter
Ben and those guys studied 30, 50 and 70% different dosages.

18:42.88
Steve
okay

18:44.27
Peter
And what they did was that the different dosages for breathing for two minutes, it just, this is a good example. They had people pull a lever. That was the exercise that they had to do.

18:56.58
Peter
And they would tell him, okay, 20 seconds after the gas started to pull a lever, 30 seconds pull a lever, and at like 60 seconds nobody could pull a lever anymore you know because they’re unconscious or starting to go unconscious.

19:10.18
Peter
You don’t want to – it’s potent. It’s a potent gas.

19:14.29
Steve
Yeah.

19:16.42
Peter
So where were we? Oh, yeah, so if anybody’s considering that, then the second important thing is that we really don’t know.

19:26.37
Steve
Yeah.

19:26.83
Peter
You know, I mean, Furtenbach tried it and had great results. Oh, great. Well, you know, one guy went over Niagara Falls in a barrel and survived too, and he had great results. You’re going to try that.

19:39.20
Peter
it needs more work.

19:39.22
Steve
Yeah.

19:41.58
Peter
I mean, I respect Furtenbach.

19:42.17
Steve
Right.

19:43.36
Peter
I think he’s, you know, I really do. But, uh,

19:47.42
Steve
Yeah.

19:49.16
Peter
I’m sure he admits that you know this ought to get some more research before it’s applied.

19:49.30
Steve
yeah

19:54.62
Peter
and then the third thing is you’ve got to be careful of claims that this could be useful. And no diss on anybody, but if you’re going to Everest and you’re going to sleep in a hypoxic tent for two months before you go,

20:15.79
Peter
so that you’ll be acclimatized to the altitude of 4,000 or 5,000 meters anyhow, and you can get into basecamp much more quickly. And then you start to climb, and you could go on high-flow supplemental oxygen as low as 6,000 meters or 6,200 meters, and you go up and on oxygen the whole come down the whole way, and helicopter back, and you’re back in Kathmandu in a few days.

20:42.79
Peter
Have you proven that xenon had anything to do with it? You know?

20:47.81
Steve
Yeah.

20:49.28
Peter
So that’s why we like to do what we call controlled experiments, where you would study just the effect of xenon.

20:52.73
Steve
Yeah. Yeah.

20:56.47
Peter
Because we know, I mean, I’ve been saying this for decades, and I think you’ve heard me say this.

21:02.47
Steve
yeah

21:04.92
Peter
What is it about Everest? It’s the altitude. You know, if Everest Base Camp were on the shores of Alaska, like in the Fairweather Range, the peak would be 3,500 tall.

21:17.63
Peter
It’s not even pretty. People wouldn’t even want to go to it. And there’d be minimal difficulty. And, but if it were the highest peak in North America, thousands would climb it, right?

21:27.80
Steve
Right.

21:28.63
Peter
So it’s an altitude problem and the body needs time to acclimatize. And you’re really pushing the extent of where, of what humans can do with hypoxia. So if you take away the hypoxia, that is you start on oxygen, you can fly into base camp, slap on the oxygen,

21:46.06
Peter
go straight up to camp two or the first day or camp one or two, stay on oxygen, go straight up to the summit and come back down. You could do it all in three days if the weather’s good, even faster if you’re super fit.

22:01.12
Peter
I’ve been saying that for decades. So what does that prove? You know, I mean, so anyhow, with the hypoxic tent and the high flow oxygen at a relatively low altitude, you don’t need anything else.

22:13.37
Steve
And I’m smiling because I’ve said similar things that I think that I could, you know, and probably tomorrow if I had a foolproof oxygen delivery system and I could breathe,

22:29.78
Steve
Yeah, the kits are so much better than they were in 1981. I mean, you guys used back then compared to you know how good those masks are now is incredible, right?

22:41.29
Steve
And they’re delivering… All the kinks have been worked out of that system, right? And you know if you deliver six or eight liters a minute, what’s the actual altitude, right?

22:51.02
Peter
Yeah.

22:52.46
Steve
like that that could be the actual thing that’s going on. So known risks.

23:01.32
Peter
We have new data, by the way. We have new data that I’ll share with you. i would like to share with you at some point about, from a chamber study showing what the equivalent altitude is at various flows of oxygen at 8,000 to 8,800 meters. It’s,

23:18.35
Steve
Oh, interesting. Yeah. I’d be very, very interested to know, know what that is.

23:22.78
Peter
well, I don’t

23:23.45
Steve
You guys have but so can you tell us or is this not published or secret?

23:27.83
Peter
want to blow it It’s not published yet, but I can tell you that, I can tell you that

23:30.91
Steve
Okay.

23:35.65
Peter
8,000 meters and above one liter permitted is adequate for sleeping or at rest. And two to three liters is adequate for most climbing. You don’t need but six is a total waste, even four is kind of waste, but, and yeah, well, that’ll be coming out later.

23:48.38
Steve
Okay.

23:52.86
Steve
Okay. Yeah, I’d like to know when that comes out. We’ll help talk about it, help you talk about it.

23:58.53
Peter
Yeah.

23:59.91
Steve
So just to kind of recap, because we’ve covered a lot of ground, we do know of at least the short-term risks around using xenon.

24:10.70
Steve
Like you said, you could perhaps pass out and die if you didn’t administer it properly.

24:14.39
Peter
yeah

24:16.91
Steve
Do we know anything about the long-term effects of using xenon in any capacity?

24:25.77
Steve
No.

24:26.85
Peter
that I know of. I’ve never seen anything written about long-term effects.

24:31.86
Steve
Okay.

24:32.42
Peter
don’t think I don’t think there would be any.

24:32.56
Steve
Yeah.

24:33.90
Peter
It’s considered safer than nitrous oxide. And I’ve never seen any long-term effects.

24:37.95
Steve
Okay.

24:41.03
Peter
and I suppose there are, but I mean, there might be, but not from these brief intermittent inhalations. I don’t think there’d be any.

24:52.03
Steve
Do you think that there, if you think about the potential around research with this gas, do you think that there’s a potential valid medical potential for Xenon and treating altitude illness or, and helping people, climb in any way?

25:16.05
Peter
Well, certainly not in treating an altitude illness. There’s nothing that’s going to be close to oxygen. That’s really all you need.

25:26.33
Peter
In terms of acclimatizing, I mean, that’s what we’re talking about.

25:32.47
Peter
I think it ought to be studied. I think it deserves more investigation. That’s my own feeling. And I know some of my colleagues say poo-poo, just, you know, spend your money somewhere else.

25:37.56
Steve
Yeah.

25:44.03
Peter
But I’m intrigued by Ferdinbach’s observation, and I think it needs to be followed up with some science. And as you have pointed out, the coaches and athletes are way ahead of the scientists when it comes to performance and these sorts of things.

25:56.75
Steve
yeah

25:59.62
Peter
So we get our ideas from, yeah you know, like the Russians showed up with it at Sochi. So we got the idea, oh man, maybe we should study this. Yeah.

26:07.75
Steve
Yeah, maybe this has an effect. they’ve already and figured out what the effect is. And I think that that’s an important thing because I think that there’s a lot of people who want to follow science, right? Yeah.

26:20.82
Peter
Yeah.

26:20.94
Steve
Also, people need to understand that, you know, I’ll use the sports example, that coaches and athletes are, competing on a weekly, monthly basis over sometimes decades, over careers, and they’re trying all kinds of stuff.

26:36.05
Steve
And just through that sheer volume of trial and error, they’re able to figure out, you know, and testing and in competition sort of what helps and what doesn’t. And they know that things like good nutrition, a lots of sleep, like, you know, sting, you know, there’s there’s certain things it’s like, if if it helps to, you know, be sleep deprived to perform better, we would have found that out and maybe all the athletes would be sleep deprived for every competition.

26:51.98
Peter
Yeah.

27:03.45
Steve
And then we would come along later and do the studies and sort of figure out why, what’s working. And I think that um, when, as a community, in a case like this, we want to look to the science and we want to say like,

27:08.91
Peter
yeah

27:17.11
Steve
Hey, does this work? Is this okay? And the reality is that this is the way it happens, that some somebody gets a an idea, they get an inkling that, you know, whether it’s from the Russians or whether it’s the doctor, I forgot, but the Austrian doctor, or maybe he’s German that you mentioned earlier, um that did the studies on the animals.

27:36.74
Peter
Yeah.

27:40.72
Steve
And then like, Hey, let’s, let’s, what, what about this? What about this application? Let’s try it, you know? And then maybe, maybe it works. And then we find out, okay, this, there’s something here.

27:52.05
Peter
yeah

27:53.47
Steve
Like clearly, Lucas is on to, feels very strongly that he’s onto something. He’s betting his reputation, his business, his everything, his life on this.

28:04.20
Steve
And, you know And to your point, maybe it’s only the effective delivery of actual oxygen. Maybe that’s the secret ingredient.

28:14.77
Steve
Maybe it has nothing to do with xenon at all. Maybe the xenon is smoke and mirrors, so to speak, to make it feel like you have something exclusive, an unrepaired, unreproducible formula. But that’s a very cynical view. I don’t think that any of us feel like, you know, Lucas is part of our community. And, you know, and I don’t think any of us feel like any of us are that cynical to try something like that.

28:41.51
Steve
So there’s I’m with you. I think that there’s something to it. I think we don’t know what it is. I think it’s going to be years.

28:52.71
Steve
But I think in our lifetimes, we will find out. And I don’t know if that is in four years or in 10 years, but it’s not going to be next week.

28:58.68
Peter
ah

29:01.27
Peter
I certainly, no, no. It’s not going to be in time for people listening to this podcast that want to use it to climb Everest, you know, or maybe not, but it depends on their age.

29:09.51
Steve
Right.

29:12.30
Peter
But I think I agree. It’s very important to be open-minded. Ah science scientists sometimes aren’t as open-minded as you think they might be. And it’s important to pick up on the things that are happening in the field and that are reported as even unique experiences.

29:31.68
Peter
It’s most important to make sure that it’s not dangerous and people aren’t going to be, you know, you don’t want to like a tick tock trend, right? Where all sorts of nonsense is going on that could be potentially harmful.

29:44.93
Peter
So one thing nice about mountaineering is there is a very strong tradition of science in mountaineering and all the initial mountaineers were scientists.

29:51.80
Steve
true.

29:53.51
Peter
They were going up there to study the atmosphere and barometric pressure and all that stuff.

29:54.61
Steve
Yeah.

29:58.57
Peter
There’s a long tradition. And you know sometimes that’s how we stumble upon things. Other times it’s just pure common sense like oxygen. And Other times we use it we’ve discovered a drug like Diamox that was based on an animal study and really nobody of course was using it for that, but you know it varies.

30:19.84
Peter
um

30:21.22
Steve
Yeah. I mean, that’s a great example. Like Diamox, those who don’t know, is ah probably if you go to your family physician and tell them that you’re going trek to Everest Base Camp, they’re going to you know, if they don’t know this already, they’re going to look it up and they’re going to come back and say, hey, we’re going to give you a prescription for Diamox. Here’s the dosage. Here’s, you know, it’s ah it’s a well understood and commonly prescribed medication to help people prevent, if you’re the expert, I should let you say this, but to prevent acute mountain sickness or to to minimize the symptoms.

30:57.07
Peter
Yeah.

31:01.24
Peter
Yeah, no, you’re exactly

31:01.28
Steve
And that came from, tell me the story of how that came. Maybe there is anything, and I’m curious if there are potential parallels to Diamox and how this may unfold.

31:15.84
Peter
You know, that’s a good question, and I should know that right off the top of my head.

31:22.21
Peter
I first became aware of it from yeah well, it had to do with this old controversy that dates back to the turn of the century in the early nineteen hundreds about whether acidifying the blood or alkalizing the blood would be good for high altitude.

31:38.05
Peter
And this was a big area of contention. And it turned out that there was some research on acidifying the blood. Ah found it useful, but it was with ammonium chloride, which was horrible to eat, and it never gained any kind of popularity.

31:57.66
Peter
And then a guy by the name Dunn studied it, said, you know, maybe there’s something to acidifying the blood to make because when you sanctify the blood, you cause the organism to breathe more.

32:11.86
Peter
And ah that’s key to high altitude acclimatization. So he studied dogs, and sure enough, the dogs had higher oxygen levels. And I think that the first study was done in soldiers.

32:26.40
Peter
And then… um

32:30.32
Peter
and sixty in 69 or 70, yeah, somewhere around that. And then 73 or 74, I came along and did the first study on Diamox in a large population of trekkers, 243 trekkers up near the Everest base camp.

32:48.68
Peter
And that, I mean, Steve, that was, what, 50 years ago.

32:54.35
Steve
Yeah.

32:54.82
Peter
50 years ago, and we still haven’t improved very much on aging. You know, it works okay, but it’s not a gold standard, and it does prevent serious mountain sickness, which is what you want.

33:07.23
Peter
Everybody can get a little mountain sick and go on, but you don’t want to get serious. Anyhow, I don’t see xenon playing any kind of role in… and that who knows?

33:20.43
Peter
I think it’s more likely to be protective for acute severe hypoxia like balloonists or something like that. But I don’t know.

33:26.97
Steve
Yeah.

33:28.32
Peter
I mean, more work needs to be done. And science, as you know, science is a very slow process. So trial and error, you’ve got to reproduce results.

33:34.90
Steve
no

33:38.77
Peter
You know like the study that showed it didn’t that xenon did not improve hemoglobin or improve performance. Well, it was a good study, but it’s one study with 12 subjects, and it really ought to be repeated.

33:55.71
Peter
Who’s going to fund those kinds of studies? I don’t know. That’s always an issue.

34:00.62
Steve
Yeah. Yeah.

34:04.26
Steve
So I’m curious to kind of just change the approach a little bit and understand that in your view, where is the ethical line between supporting an adaptation that the body has to something like high altitude and pharmacologically engineering human performance?

34:25.39
Peter
Yeah, well, and you know, that’s a big issue. As a doctor who’s trying to keep people safe in the mountains, it’s not much of an issue for me.

34:31.74
Steve
Mm-hmm.

34:35.02
Peter
I mean, I have my medical ethics, which is to prevent morbidity and mortality and keep people healthy. ah The…

34:47.19
Peter
and I have moral issues, but I don’t have much in the way of ethical issues around climbing. I mean, the ethics of climbing is determined by climbers. You know, it’s a kind of consensus of a culture opposed to moral issues.

35:03.19
Peter
And, uh, Climate is non generally non-competitive. People aren’t out there too, well, now they are with FKTs and things, but they’re generally out there to enjoy themselves, to enjoy the mountains, to have a great time. They’re not competing.

35:18.69
Peter
Who cares what WADA says? This is not a WADA-sanctioned sport in that you’re not competing for money or goods or things. And so I don’t have any qualms.

35:31.02
Peter
I don’t have any issue whether it is sporting or not. If somebody wants to go to Kilimanjaro, they have two weeks off. They can only do a six-day trip, for example.

35:42.70
Peter
Hell, yes, they got to take Diamox. That’s the only way. They’re that’s I mean, it improves their safety and success rate dramatically. And the same thing. If somebody’s going to Everest as a physician, I have to advise them to use oxygen.

35:57.77
Steve
Mm-hmm.

35:58.06
Peter
I shouldn’t say that. I have to present all the risks and benefits of using oxygen or not. Let them decide for themselves. But I don’t understand a lot of this ethical stuff about… Yeah, there can be a fine line between what supports adaptation. So that means acclimatization. What supports acclimatization?

36:24.10
Peter
adequate sleep, healthy, healthy lungs, for sure.

36:24.67
Steve
ah

36:27.34
Peter
That’s the most important gradual ascent to high altitude.

36:32.69
Steve
Mm-hmm.

36:34.46
Peter
What about hypoxic tents? Is that an ethical thing? WADA looked at it and decided they would allow it because why should the people who can go to an altitude training camp and come back have a big advantage over people who can’t afford that, but could use a tent?

36:49.19
Peter
You know, that was the rationale. But then, now, it gets a little murky territory and they certainly banned EPO. But just because WADA banned something doesn’t mean climbers should not use it.

37:05.55
Peter
So I don’t know. I’m all It’s really not an issue it’s really not an issue of

37:14.96
Peter
pharmacologically enhanced acclimatization. Acclimatization is what you want. Well, this is where it gets tricky. Your goal is acclimatization, unless you’re going to climb with oxygen, and it doesn’t matter.

37:28.45
Peter
And anything that supports acclimatization, I think, is good. And, you know, does blood doping support acclimatization? Well, it supports your increase in red blood cells, but we know it’s not nearly as good.

37:45.76
Peter
as living at high altitude and spending more time at high altitude. And, you know, if people have an issue with, they want to do something that’s sporting, well, that means they’re going to not use oxygen on their seven or 8,000 meter peak.

37:58.96
Peter
And they’re, you know, they may use a sleeping pill to help them sleep, or they may use ibuprofen for a headache, but they’re not going to use Diamox probably because that promotes acclimatization. But I, you know,

38:13.25
Peter
What I find interesting is there are all these people that are, or a lot of them, who are spouting about, oh, it’s not sporting use Diamox or dexamethasone, which we reserve for treatment, as you know, generally speaking, are the same ones that are using oxygen.

38:28.72
Peter
There’s really only one drug that’s been shown to reliably enhance performance at high altitude, and that’s oxygen. And it has no side effects.

38:41.59
Peter
It’s safe. It is a drug. It’s considered by the FDA a drug. And, you know, if you’re going to use oxygen, don’t talk to me about sports or dexamethasone or anything else. You know, and of course I advocate the use of oxygen because I think it’s much, much safer.

38:58.75
Peter
And, uh, but that, yeah.

39:00.22
Steve
Of course. yeah

39:02.03
Peter
Anyhow, that is a tricky conversation.

39:03.80
Steve
Yeah. Yeah.

39:06.31
Steve
It’s a very tricky conversation. And, you know, one of them, I myself have been on the other side of that in the past where I used to be very critical of people using oxygen or, you know, any kind of, let’s say, um, aid.

39:10.36
Peter
Yeah.

39:22.04
Steve
Um, and at the same time, I strongly believe in the mountains as being a place of freedom. where I can do what I want, and why I’m going there on my terms.

39:34.49
Peter
yeah

39:34.38
Steve
And then it’s like, what immediately begs the question is like, so what right do I have to dictate the terms to someone else? Right? Like the freedom of the hills, that’s the classic phrase that we all have used and all come up with around the sport.

39:48.33
Peter
yeah

39:48.41
Steve
And I think that it really comes down to, you know, declare your aids and and just do it for yourself, right? Like if you’re going to use,

39:59.90
Steve
all the things, use all the things, but don’t say you did it without all the things when you really did. That’s, that’s I think, that’s less unclear, right? Now you’re saying you did this climb without oxygen and without dexamethasone, without diamox, without xenon, but you actually…

40:17.97
Steve
did take all employ all those means, then that’s a problem. And so as long as people are sort of saying, and I think that that’s one of the things I respect with Lucas’s approach, he is saying like, Hey, we’re going to go do this. We’re going to try this thing. I’ve tested it on myself.

40:34.45
Steve
We don’t know, you know, and it’s declaring his aides, right? Like he’s not saying, you know, he’s not just sort of hiding that. And then he climbs Everest in a week with four people. And then,

40:46.05
Steve
Everybody’s scratching their heads like, how did you do that? If you know various things, he’s explaining ahead of time how he’s planning to do that. And maybe it works, maybe it doesn’t. Well, you’re going to find out here in the next few weeks.

41:00.79
Peter
Well, we’re not really though. You know, if he were doing, if he were doing just Xenon and went running up every within a week, yeah, holy cow, we would know it’s Xenon, but you’re doing pre-economization oxygen on the mountain.

41:03.37
Steve
Yeah, fair.

41:07.39
Steve
Great.

41:13.12
Steve
Right.

41:15.81
Peter
There’s no way to know what Xenon’s doing.

41:18.50
Steve
Yeah. Yeah. And they are doing those things.

41:19.56
Peter
That’s where the controlled experiment comes in as being valuable, you know?

41:21.02
Steve
So, yeah. Yeah. Yeah.

41:25.84
Peter
Yeah.

41:27.14
Steve
Yeah. So

41:31.24
Steve
want to, we

41:36.34
Steve
Yeah, we’ve covered a lot of ground here. I think it’s been really informative.

41:39.51
Peter
Yeah.

41:40.50
Steve
And one of my goals with this is to really give people as much information as we have about this topic. My goal is not to make up anyone’s mind for them or tell them how to think. It’s just simply to provide information and let people make their own conclusions.

41:59.30
Steve
And we’ve covered a lot of what we know. Is there anything that you know personally professionally as a researcher about not just xenon, but well, specifically xenon, but also these types of non-oxygen, let’s call them drugs, that that we should be aware of as a community that we should be thinking of. We don’t really know the long-term effects. We know some short-term effects.

42:29.00
Steve
We know it’s expensive. Like there’s some basic, basic information out there. But what, what other, what other things should we know?

42:34.44
Peter
you know

42:40.27
Peter
A couple of things. One you touched on earlier, and that is how to assess the state of the art in terms of the science and whatnot. And, you know, in the UIA, the UIAA statement on xenon came out pretty quickly and it stated that there’s no evidence that it’s beneficial.

42:50.82
Steve
Yeah.

43:02.83
Peter
And I think what people need to understand is that

43:09.46
Peter
The absence of evidence does not mean that there’s evidence of absence of effect. This is a phrase we use in science all the time. Yeah, it’s not been shown to be helpful in the mountains.

43:18.61
Steve
yeah

43:20.33
Peter
Why? Because it’s never been studied in the mountains.

43:23.47
Steve
Yeah, yeah, yeah.

43:24.88
Peter
So, yeah,

43:26.32
Steve
So chicken and egg.

43:28.05
Peter
So a clearer statement is no one has yet studied it in the mountains, so we don’t know. which is the same as saying there’s no evidence that it works, but it, you know, it’s a little more accurate.

43:38.03
Steve
Yeah.

43:45.01
Peter
So that’s one thing. And, you know, as a physician, I would advise my clients not to try it until we have some sort of science and then we’ve figured out whether it can really work or not, you know.

44:01.49
Peter
That would be my own advice. Yeah. I’m generally an early adopter of new technologies and new therapies, but this is a very powerful thing that costs a lot. It may not be worth it unless we can show it. It can actually be of some benefit. So it’d be helpful to do a controlled experiment.

44:25.41
Peter
The second thing is, yeah, you know, I got high altitude medicine because I love being in the mountains. And there I was working for the Himalayan Rescue Association at 4,400, well, 4,200 meters in Nepal.

44:44.72
Peter
And, oh, my God, seeing all these people come by getting sick, I thought, see, I got the flu when they came to the Khumbu. I finally realized, wait a minute, this must be altitude sickness.

44:57.09
Peter
And that’s how I started my career. Where was I going with that?

45:03.88
Peter
You know, it depends on people’s motivation.

45:04.43
Steve
Yeah. Yeah.

45:05.87
Peter
If your motivation is going to the mountains in order to get away from technology in the world and find yourself and push your limits and meet chirpas or other cultures and immerse yourself in other cultures, what’s the big rush?

45:21.45
Peter
You don’t need any drugs.

45:21.77
Steve
yeah

45:22.53
Peter
Just plan an extra week. on your trip and take time to acclimatize and you’ll be very comfortable and you won’t get sick.

45:25.23
Steve
yeah

45:29.23
Peter
And you, you know, it takes seven to 10 days to start improving your exercise performance. Once you arrive at 3,500 or 4,000 meters. So it takes that much time.

45:40.37
Steve
yeah

45:41.19
Peter
But then other people are motivated that, uh, no, they gotta do Everest. They gotta punch their ticket and they’ve only got two weeks to do it. And so they’re gonna pay a fortune in order to try to, you know, totally different motivation.

45:55.24
Steve
And I think it’s a slippery slope when we start evaluating or judging other people’s motivations. You know, I mean, there’s, there’s, there’s things that I’ve done in my life that I’m sure

46:09.20
Steve
especially in climbing them, most people would not do it. They would think that that’s ridiculous, like but not put their foot in my boot and that’s okay.

46:17.06
Peter
yeah

46:17.82
Steve
Right. Like, and I think it goes the other way too.

46:22.86
Peter
Yeah, we don’t want to be judgmental. On the other hand, we watch with some horror, if want to use a strong word, at what’s happening on the you know the Great Peaks.

46:38.70
Steve
Yeah.

46:39.82
Peter
It’s just not what it was 30 or 40 years ago when we first started. Of course, you can say that about most things, but you have to learn to put up with that.

46:51.44
Peter
And if you don’t like the crowds, you know, go to the Northwest Buttress of the Dolly instead of the West Buttress or, you know, go try a different route on Everest or a different peak or something.

46:59.43
Steve
Yeah.

47:03.01
Peter
Yeah. Anyhow.

47:05.82
Steve
Yeah. Yeah. How has your own relationship with risk changed over your career? Like, you know, you climbed Everest 1981, you know, 111 people to do so. Now it’s, you know, hard I don’t know, thousands.

47:22.75
Steve
Sometimes it makes so many, sense in one day, right?

47:23.10
Peter
Yeah.

47:25.56
Steve
So, you know, how does that change over your life? Mm-hmm.

47:33.44
Peter
My assessment risk?

47:38.05
Peter
Well, you know, with age, one gets more conservative and has other responsibilities and family responsibilities that I didn’t have when I was 33 on Everest. And like you, I’ve seen in a lot of my friends die and, um,

47:59.46
Peter
It’s certainly sobering. So sure, the risk calculus changes as we age. And what I’m really into is managed risk, you know like which is what I think all the climbers should be.

48:10.08
Steve
Mm-hmm.

48:12.43
Peter
In other words, really looking objectively at the risk and being realistic and then figuring out how to manage those and then deciding, then making a decision.

48:25.27
Peter
You know, is it

48:29.02
Peter
I mean, look at last year’s Denali. A couple of guys from Colorado, they were living in Colorado, so they were at medium altitude. They thought they were well enough acclimatized to go from the airstrip up to the 4,300-meter camp very quickly, so they did it a day and a half.

48:51.49
Peter
And then a guy died of altitude sickness. Now, that was a risk that you could certainly foresee. And easy to mitigate. You just put in two or three camps before you get to 4,300 meters, you know.

49:05.02
Peter
So, you know, some of these risks are just based on ignorance, I guess. I mean, estimate it’s an incorrect risk assessment, you know.

49:14.19
Steve
right and that’s one of the things I think with this xenon topic that I want to bring more information to the topic because I think there’s a lot of misinformation and just a vacuum of knowledge around this topic. And what I don’t want to see is someone saying, Hey, I want to set an FKT on Montblanc.

49:31.91
Steve
Um, I heard Xenon is good. I got to get a hold of a bottle on the internet somewhere. And like what you said, and then they, you know, they, they, they are found dead in their apartment in Chamonix the next morning because they, you know, didn’t have all the tools. Cause they just thought this was a shortcut to high performance.

49:51.18
Steve
And I think that that’s a real risk too, right? Like there’s a lot, the hype cycle is pretty high on this topic right now.

49:56.41
Peter
Yeah. and

49:59.97
Steve
And there’s a lot we don’t know. And I think when you talk to Lucas, you find out that like, you know, he’s a very smart, but also a very calculating person. I mean, any mountain guide becomes an excellent mountain, you know, manager of risks, especially when you’re guiding in high risk environments, like 8,000 meter peaks, but,

50:20.52
Peter
yeah

50:20.71
Steve
That is, their approach is, while it’s sort of, let’s say, a trade secret, it’s also very deliberate and careful how they’re approaching this. You know, they do have medical doctors, they do have the machines, they are doing it in a clinic or a hospital, I don’t know and they don’t say, they don’t have to say.

50:44.26
Steve
And I think that is a really important context for people to understand.

50:51.33
Peter
Yeah, absolutely. I mean, let’s keep a bit of it alive. And I have to see what happens. You might have somebody marketing a handheld xenon gas device, you know, in the next few months or something.

51:02.74
Peter
God knows.

51:03.77
Steve
Yeah, right, right.

51:04.46
Peter
It could get really crazy. So I’m really glad that you’re doing this podcast to tell people that There’s a lot we don’t know about Xenon. It’s very experimental and holds off until we get a little more experience with it.

51:21.80
Peter
And yeah, I think that’s what you’re doing a great service.

51:22.37
Steve
Yeah, yeah, yeah.

51:27.84
Steve
Well, because of your help, thank you for that. So I’ve got to ask you about touring with the stones. Like you and I’ve heard some of these stories in the past and, you know, first of all, just like, how did it come to be that Peter Hackett became the tour doctor for the stones?

51:37.80
Peter
yeah.

51:51.55
Peter
high altitude. They were touring in Mexico City. They were worried about the altitude, so they gave me a call. That was 2006 on the Bigger Bang Tour.

51:58.47
Steve
There you go

52:02.03
Peter
We hit it off, and then they decided they wanted a full-time doctor. I’m one of three doctors that rotate through with them. I’ve been with them now for 20 years, going 20 years.

52:18.23
Peter
and you know it’s a different kind of risk assessment. They have a whole security team that protects them from the risks of yeah know all sorts of things.

52:36.24
Peter
It’s really interesting and it’s been kind of, and it’s been fun and you know, they don’t, it’s not that much time. They only tour, they don’t even tour every year. They tour every couple of years, maybe for a few months. So it’s not, it’s not too bad.

52:52.78
Peter
And I can’t say much about it.

52:56.68
Steve
All right. Well, I expect ah I expect a backstage pass in my future, Peter. That’s all I have to say.

53:02.82
Peter
Oh, for sure. sure. If they ever tour again. Yeah.

53:08.10
Steve
Yeah, dude. Yeah, that’s maybe the most important thing is finding out where they’re going to tour and where we could get tickets.

53:11.04
Peter
They’re planning on it.

53:14.91
Steve
I know that they were not in Munich a couple of years ago. I don’t know if you were at that show, but that was the last time they were.

53:21.00
Peter
Yeah.

53:22.91
Steve
I heard that they were close to where I’m sitting here in Austria.

53:25.43
Peter
Yeah.

53:26.67
Steve
So, okay.

53:27.95
Peter
Well, stay tuned.

53:30.21
Steve
I will.

53:30.90
Peter
Vienna has a lot of promise.

53:33.69
Steve
All right.

53:34.88
Peter
Okay.

53:35.16
Steve
Good. I’d love to get my boys, like Francie and Seppi, my kids are getting really into music and my, and my older one who’s nine last weekend asked me if I’d ever heard of a band called Metallica because it’s his new favorite band.

53:53.06
Peter
This is too much, man.

53:53.64
Steve
but like, yeah, yeah, I know a little bit about ah so So they’re going in a good direction.

54:00.22
Steve
I think the Stones are a critical part of that education, though. It’s all part of it.

54:05.39
Peter
Classics. Yeah. Classic.

54:07.16
Steve
Classics.

54:08.45
Peter
Classic.

54:08.35
Steve
Classics.

54:09.51
Peter
All right.

54:09.54
Steve
Well, thanks so much for your time and your expertise and your opinions. And, ah you know, it’s such an honor to have you here and helping to share your wisdom and hard-earned knowledge with this community. So thank you, Peter.

54:23.65
Peter
Thanks, Steve. Good to see you again.

54:25.82
Steve
Good to see you. All right.

54:27.14
Peter
Okay. Bye now.

54:28.48
Steve
Bye.