Shilajit: A panacea for high-altitude problems

High altitude problems like hypoxia, acute mountain sickness, high altitude cerebral edema, pulmonary edema, insomnia, tiredness, lethargy, lack of appetite, body pain, dementia, and depression may occur when a person or a soldier residing in a lower altitude ascends to high-altitude areas. These problems arise due to low atmospheric pressure, severe cold, high intensity of solar radiation, high wind velocity, and very high fluctuation of day and night temperatures in these regions. These problems may escalate rapidly and may sometimes become life-threatening. Shilajit is a herbomineral drug which is pale-brown to blackish-brown, is composed of a gummy exudate that oozes from the rocks of the Himalayas in the summer months. It contains humus, organic plant materials, and fulvic acid as the main carrier molecules. It actively takes part in the transportation of nutrients into deep tissues and helps to overcome tiredness, lethargy, and chronic fatigue. Shilajit improves the ability to handle high altitudinal stresses and stimulates the immune system. Thus, Shilajit can be given as a supplement to people ascending to high-altitude areas so that it can act as a “health rejuvenator” and help to overcome high-altitude related problems.


HYPOXIA AND WEAKNESS INCLUDING MUSCULAR DEGRADATION
Shilajit amplifi es the benefi ts of other herbs by enhancing their bioavailability in the body. [16] It contains more than 84 types of minerals, including the main ingredient, fulvic acid, [12,13,18] and provides most of the essential minerals to the body. [13,16] Fulvic acid acts as a carrier molecule in the human system, helps in the transportation of nutrients into the deep tissues, and removes deep-seated toxins from the body. [19] Shilajit helps in energy production, reduces the recovery period of injured muscles, bones, and nervous system, [14,15,18] and is used in the treatment of fractures. [13,15,18] Hence, it reduces the degradation of muscles and bones, and increases their strength at high altitudes. Shilajit also has the ability to overcome physical as well as mental stress [17,18,34] due to which it is used in the treatment of tiredness, lethargy, cold etc. which are common problems at high altitudes. Bucci (2000) [14] and Frawley et al., (2001) [17] have reported that the consumption of Shilajit with milk constitutes one of the strongest natural supplements with the potential to eliminate all kinds of weakness. Fulvic acid helps in the absorption of iron into the body, making it bioavailable to bone marrow stem cells for blood formation [16,25] and hence, Shilajit can be very helpful in coping with hypoxia-like conditions in the body. Apart from its blood-purifying property, Shilajit also enhances the oxygen-carrying capacity of the blood. [16,25] It helps in improving blood circulation and its diffusion into tissues, and maintains the necessary oxygen levels in the body during hypoxia. [17] Dash (1991) [16] has reported that Shilajit is a good detoxifi er, helping in the elimination of toxins from the body, and its regular use stops the production of toxins in the body. Hence, Shilajit is also used in the treatment of carbon dioxide poisoning in hilly areas.

HIGH-ALTITUDE PULMONARY EDEMA AND PAIN (HAPE)
HAPE is a major problem at high altitudes, which develops due to oxygen defi ciency as well as low atmospheric pressure. [43][44][45] In HAPE, fl uids are accumulated in the lungs of the body and some of the symptoms are shortness of breath, chest pain, fever, lethargy, cough, and cyanosis. [1] Being a diuretic agent, Shilajit removes the excess fl uid from the lungs as well as the body, [17,34] which makes it very effective in the treatment of HAPE-like conditions and edema. [17] Shilajit has analgesic and anti-infl ammatory effects and is thus useful for different painful conditions of the body. [24,40,46] Shilajit is also found to be very benefi cial in rheumatoid arthritis, osteoarthritis, and gout [13,22,40] as it nourishes the joints and reduces the infl ammation and pain. [13,22,47] Dash (1991) [16] has also reported that Shilajit can be useful in the treatment of dyspnea.

HIGH-ALTITUDE CEREBRAL EDEMA AND DEMENTIA (HACE)
HACE is the result of swelling in the brain tissue due to low atmospheric pressure. Symptoms include headache, loss of coordination, weakness, and decreased level of consciousness, including disorientation, loss of memory, hallucination, psychotic behavior, and coma. [48,49] It generally occurs after staying for a week or more at high altitudes. Severe instances can lead to death if not treated quickly. Shilajit can be very useful in the treatment of HACE-like conditions of the brain as it maintains the extracellular volume in the body through its diuretic action, and removes the excess fl uid and toxins from the brain as well as the body. [17,34] It improves memory and enhances confi dence for better handling of stress; [13,18,23,34] it also has very good antioxidant properties. [13,16,22,47] Dementia is one of the common problems faced by mountaineers, which occurs due to degradation of neurons, either by hypoxia or by free radicals or toxins in the brain. Shilajit may play a potential role in the treatment of Alzheimer's and Parkinson's diseases [24] as it is an immunostimulant and has been found to be very effective in treating immune, nervous, and urinary disorders. [13,15,16,18,21,22,34,50] Jaiswal et al. (1992) [23] revealed its anxiolytic activity and its usefulness in the treatment of disinclination to work. Shilajit is also used as a tonic in the ayurvedic system of medicine due to the presence of humic acid, fulvic acid, coumarins, and triterpenes. [17,41]

GASTROINTESTINAL DISORDERS AND DEHYDRATION
Gastrointestinal distress (lack of appetite, constipation, diarrhea, nausea, vomiting) is another major problem seen at high altitudes [1] and dehydration is a common problem faced by mountaineers. Shilajit is an important drug that helps in the digestion and absorption of food in the gastrointestinal tract (GIT) [25,51] and is also useful for the treatment of nausea, vomiting, and digestive disorders. [15][16][17] Being an excellent source of nutrients, it used as a tonic and helps in the better utilization of food. [16,51] It stimulates the pancreas to secrete insulin and maintains an equilibrium of catabolism and anabolism in the body [13,17,25,34] It also has a laxative property in the human body. [25] Frawley (1989) [34] suggested that the Shilajit could also act as a gastric tonic whereas Goel et al., (1990) [46] revealed that Shilajit increases the carbohydrate/ protein ratio and decreases the gastric ulcer index. The fulvic acid and 4-methoxy 6-carbomethoxybiphenyl present in Shilajit decrease acid-pepsin secretion, cell shedding, and also act as ulcer protectives. [40,41] Thus, Shilajit can be very useful to cope with common high-altitude problems like gastrointestinal disorders and dehydration.

RADIATION PROTECTION
The high intensity of solar radiation, particularly, the high intensity of UV radiation, also affects people at high altitudes. [4] The refl ection of UV and solar radiation is quite high in snowbound areas compared to the plains. [3] Hence, the risk of sunburn, skin, and eye diseases, even skin cancer, is more at high altitudes. [1] Shilajit can be useful for the treatment of skin and eye disorders due to its photoprotective action. [17,34]

ACCLIMATIZATION AND IMMUNOSTIMULATION
Acclimatization is a major problem for people who go to high altitudes for the fi rst time. Shilajit is very helpful in improving the immunity of the body [34,42,50] as it activates macrophages and splenocytes, and hence, has been shown to have adaptogenic properties. [42,52] Thus, it is very helpful in acclimatizing to environments in hilly areas, [50] and has also been shown to reduce tumor growth. [18,53] Shilajit also has anti-allergic activity against histamine releasers and has been seen to induce degranulation of mast cells. [25,52] Thus, it can also be used in the treatment of allergic conditions.

MECHANISM OF ACTION
Shilajit contains active organic molecules such as fulvic acid along with minerals (in their ionic forms). The fulvic acid helps in the transportation of these minerals into cells for maintaining and restoring their electrical potency, which prevents their decay and death. Shilajit helps in metabolism and promotes energy production in the body. It maintains an equilibrium of catabolism and anabolism, enhances the absorptive and detoxifying capacity of the body, and stimulates the immune system and blood formation in the body.

DOSE
The recommended dose of Shilajit for maintenance of optimal health is 300-500 mg/day. Shilajit powder taken with milk twice a day will ensure optimal blood levels and therapeutic effi cacy. [27,28,34] It is slowly metabolized and reaches a maximum level in the blood after 12-14 hours of consumption.

INDICATIONS/COUNTERACTION
Shilajit is safe for everyone and has been found to be quite safe for up to 3 g/kg body weight in mice. [50] It should not be used with horse gram, meat of pigeon, Solanum nigrum (black nightshade). [25,27,39] Raw and unprocessed Shilajit should not be used as it contains a signifi cant amount of free radicals and has been found to be contaminated with different fungal organisms such as Aspergillus niger, A. ochraceous, and Trichothecium roseum.

CONCLUSION
Shilajit is an ayurvedic drug with a long history of human use and has been used in nervous, diabetic, urinary, immune, cardiac, and digestive disorders, and is also used as a performance enhancer. [14][15][16][17][18] Traditionally, it has been recommended for the cure of almost all kinds of human diseases. Ancient works such as the Hindu Materia Medica, Charaka Samhita, and Susruta Samhita also describe the medicinal properties of Shilajit. Hence, it is a highly recommended drug in the ayurvedic and other traditional medicine systems of India. It would certainly be helpful to fi ght against common high-altitude problems like hypoxia, AMS, HAPO, HACE, dehydration, UV radiation etc when taken as a supplement by people ascending to high altitudes.
In light of Shilajit's tremendous medicinal potential, it would not be an exaggeration to say that it can be a panacea for all human ailments and Nature's wonderful gift to mankind.