The Andes run through Peru, Bolivia and Ecuador, and they bring together Inca ruins, colonial cities, volcanoes and salt flats. They also bring altitude: Cusco sits at about 3,400 m (11,150 ft), and La Paz is higher still. The best routes are the ones that let your body adjust.
The main destinations
Cusco and the Sacred Valley, Peru
Cusco was the Inca capital, and Inca stonework still forms the base of many colonial buildings. Spend a day or two in the city itself (Qorikancha, the San Pedro market, the San Blas neighborhood), then drop to the lower Sacred Valley (around 2,800 m), where Pisac, Ollantaytambo and the Maras salt pans are easier on the lungs.
Machu Picchu, Peru
The classic Inca site sits lower than Cusco, at about 2,400 m. Most people take the train from Ollantaytambo or Cusco to Aguas Calientes, then a bus up to the ruins. The alternative is the multi-day Inca Trail, which requires a permit booked months ahead.
- Entry tickets are timed and limited, so book early.
- Aim for a morning entry, or stay overnight in Aguas Calientes to arrive early.
Quito and Cotopaxi, Ecuador
Quito’s old town is one of the best preserved in Latin America. The city sits at about 2,850 m. A day trip can take you to Cotopaxi National Park, where an almost perfect snow-capped volcano rises above the grasslands, and to the Quilotoa crater lake on the Quilotoa Loop.
La Paz and Salar de Uyuni, Bolivia
La Paz is a dramatic city in a canyon, with a cable-car network (Mi Teleférico) that doubles as a sightseeing tool. From there, a flight or overnight bus takes you to Uyuni, where multi-day jeep trips cross the world’s largest salt flat, with flamingo lagoons and red lakes along the way.
Three altitude-smart routes
Cusco first (7–9 days)
Fly into Cusco, spend one or two days taking it slowly, then descend to the Sacred Valley and Machu Picchu. Return to Cusco for a last day. This is the most popular and straightforward plan.
Quito arc (7–8 days)
Quito, Cotopaxi, Quilotoa, then a few days in the Amazon or on the coast. Altitude gain is gradual.
Altiplano loop (10–12 days)
Lima or Cusco, Lake Titicaca (Puno or Copacabana), La Paz, Uyuni. This is higher and more demanding, so do it after a few days at moderate altitude. Don’t rush the first days in La Paz.
Altitude and planning tips
- Take it easy on arrival. Rest, walk slowly, eat lightly and skip alcohol on the first day.
- Drink water, and try coca tea, which locals use to ease mild altitude symptoms.
- Sleep lower if possible. Basing yourself in the Sacred Valley first is an easy way to acclimatize.
- Ask your doctor about altitude medication such as acetazolamide before you go, especially if you have heart or lung conditions.
- Don’t ignore symptoms. Severe headache, confusion or breathlessness at rest mean descend and get help.
- Add buffer days. Strikes, road blockages and weather can disrupt transport, especially in Peru and Bolivia.
- Pack layers. Days can be sunny and warm, but nights are cold, and the sun at altitude is intense.
If you can only see one place, make it Cusco, the Sacred Valley and Machu Picchu. Add Uyuni or Quito if you have another week.
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