Dangerous Eructations! Science finally addresses an alpine menace that many fall victim to, but few are talking about.

We've all been there, behind your buddy on the skin track and he rips one right in your face. Confined by the track, you can't dodge left or right, and the rancid odors of his metamorphosed egg-and-sausage breakfast sandwich filter straight through long underwear and gore-tex straight to your nostrils. Trail bombed.

Hikers, skiers and climbers alike have been "passing wind" on windy passes since time immemorial, and invariably, when they're caught, blame their alpine eructations on beans, TVP, or the closest guy. I always suspected there there was a more systematic problem going on, and I'm so glad I stumbled upon this letter in a leading medical journal (don't ask me how--long story), in which research physicians get to the heart of the matter of why we fart more in the mountains. 

If you grew up on climbing literature like me, or ever watched Vertical Limit or any other trashy B-rated "adventure films", you're familiar with the terms HAPE and HACE, serious life-threatening conditions which result from prolonged exposure to low atmospheric pressure. But have you heard of HAFE? It's time we quit fooling ourselves and start having an honest conversation about high altitude flatus expulsion.

By the way, have you ever used the word eructation? Neat, huh.


...from THE WESTERN JOURNAL OF MEDICINE

High Altitude Flatus Expulsion (HAFE)

TO THE EDITOR: We would like to report our observations upon a new gastrointestinal syndrome, which we shall refer to by the acronym HAFE (high altitude flatus expulsion). This phenomenon was most recently witnessed by us during an expedition in the San Juan Mountains of southwestern Colorado, with similar experiences during excursions past. The syndrome is strictly associated with ascent, and is characterized by an increase in both the volume and the frequency of the passage of flatus, which spontaneously occurs while climbing to altitudes of 11,000 feet or greater. The eructations (known to veteran back-packers as "Rocky Mountain barking spiders") do not appear to vary with exercise, but may well be closely linked to diet.' The fact that the syndrome invariably abated on descent leads us to postulate a mechanism whereby the victim is afflicted by the expansion of colonic gas at the decreased atmospheric pressure of high altitude. This is somewhat analogous to the rapid intravascular expansion of nitrogen which afflicts deep-sea divers and triggers decompression illness. While not as catastrophic as barotrauma nor as debilitating as HAPE (high altitude pulmonary edema), HAFE nonetheless represents a significant inconvenience to those who prefer to hike in company. Some experience from recent Everest expeditions suggests that the use of digestive enzymes and simethicone may minimize the hazard.

At present, we can advise victims that the offense is more sociologic than physiologic. HAFE should be added to the growing list of medical disorders that are associated with exposure
to high altitude. We are planning a prospective study for the summer of 1981.

PAUL AUERBACH, MD
Assistant Professor of Medicine
Attending Physician, Emergency Services
Temple University Hospital
Philadelphia

YORK E. MILLER, MD
Research Fellow
Pulmonary Division
Department of Medicine
University of Colorado Health Sciences Center
Denver

REFERENCE
1. Levitt MD, Lasser RB, Schwartz JS, et al: Studies of a
flatulent patient. N Engl J Med 295:260-262, Jul 29, 1976

THE WESTERN JOURNAL OF MEDICINE 173

So before you panic, remember that farting in the mountains is not "barotrauma" not as deadly as HAPE, a condition where you end up drowning from the water in your lungs. At worst, you will just annoy your friends for about 5 seconds and at best get a great laugh as they moan and try to jump out of the way. Besides, "the offense is more sociologic than psychologic". Thanks for clarifying guys. Happy trails, and on ascents in the mountains, leave a little extra space between you and the guy in front.