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in the rate of growth is a response to 
poor nutrition and how much is a re- 
sponse to hypoxia, the third and most 
severe source of stress in high-altitude 
areas. Most experts on the growth of 
Andean natives, such as A. Roberto 
Frisancho and Jere D. Haas, feel that 
both hypoxia and poor nutrition are im- 
plicated but tend to emphasize the 
former. The Andean data also suggest 
that slow growth is a developmental, not 
a genetic, response to high-altitude con- 
ditions. On the other hand, I.G. Pawson 
has concluded that slow Sherpa and 
Tibetan growth may be programmed 
genetically. 
Because of hypoxia’s severity, one 
might expect the cardiovascular and 
pulmonary responses of all high-altitude 
populations to be the same. Intriguingly, 
however, the Quechuas of the altiplano 
and the Sherpas of Khumbu may not 
possess the same kinds of adjustments. 
The best way to understand the charac- 
teristics of the two is to follow the path- 
way of oxygen from the air breathed by 
the lungs through the circulatory system 
to the active tissues. 
The diffusion of oxygen from the 
lungs into the blood is affected by the 
size of the lung surface, the amount of 
air that is moved into and out of the 
lungs per minute, the amount of blood 
that passes through the lungs, and the 
speed at which it does so. Research in 
Nunoa and elsewhere in the altiplano 
has revealed that the chest sizes of Que- 
chua children and adults are larger than 
those of people in the United States, 
even though Andean natives are phys- 
ically much smaller. This feature has 
been linked to their large lung volumes. 
On the other hand, the Sherpas have 
smaller chests than Quechuas of similar 
age, and adult lung volumes are far 
lower. The larger lungs of Andean na- 
tives indicate a greater surface area for 
the diffusion of oxygen into the blood. 
Another factor affecting diffusion is 
ventilation — the amount of air that is 
moved into and out of the lungs per 
minute. For both Quechuas and Sher- 
pas, ventilation is greater than for low- 
landers tested at sea level. Among both 
groups of highlanders, however, sensitiv- 
ity to low levels of oxygen in the blood is 
reduced, so that hypoxia-induced hyper- 
ventilation — so common among low- 
landers tested at high altitudes — does 
not occur. This so-called blunted hy- 
poxic drive may prevent a dangerous 
fall in the level of carbon dioxide in the 
blood, which normally accompanies hy- 
perventilation. 
Among lowlanders who remain a 
80 
