In 1981, Drs. Paul Auerbach and York Miller first reported the phenomenon of High Altitude Flatus Expulsion (HAFE) in the medical literature. There was a flurry of letters in response to this discovery proposing pathologic mechanisms and potential impacts. However, little was done by the medical establishment to prove the syndrome’s mechanism or discover a solution to prevent psychological trauma to those afflicted. Some cures have been proposed in the lay press, but no reports on the efficacy of these treatments exist.
In April of 2022, along with 15 other fourth-year medical students, I ascended more than 10,000 feet above sea level to Breckenridge, CO, to participate in a Wilderness Medicine elective. The report from Drs. Auerbach and Miller prepared us for an increased frequency and volume of Rocky Mountain Barking Spider attacks, but we did not know what to expect of the pungence of our flatus. We hypothesized odor would be significantly reduced because of a dilutional effect since the proposed mechanism of HAFE is the expansion of colonic gas due to decreased atmospheric pressure following Boyle’s Law. Yet, we were surprised when we discussed our wind-breaking habits on arrival at altitude.
First, about half of our group did not notice any change in our flatus frequency, volume, or odor. Of course, we were below the threshold of 11,000 feet proposed by Auerbach and Miller, but many of us came from sea level and, by Boyle’s Law, would expect a 44% increase in the volume of flatus. Those who noticed an increase in volume and frequency of flatus reported a return to normal gaseous levels after about two days, which is also noted in the lay literature. These observations fly in the face of the proposed mechanism of HAFE.